LNC CENTER - Legal Nurse Consulting Certification Programs!

Full Name:
Date:
Your Address:	Your address here
City:
State:
Zip Code:
Email Address:
Phone:
Nursing Licence:
Is your license in good standing w/Board of Nursing?
Nursing Specialty (or Area of Practice):
Which Program would you like to take?
2 Day Accelerated LNC Certification Program
VIP Basic Program
VIP Gold Program
VIP Platinum Program
City of Seminar:
Date of Seminar:
or
Home Based Program?:	Yes No
CANCELLATION POLICY: Full refund (minus $100 Registration Fee) with 7 or more days notice. IF CANCELLATION OCCURS 6 DAYS OR LESS, YOU MAY RECEIVE FULL TUITION CREDIT TOWARDS A FUTURE PROGRAM OFFERED, NO MONIES WILL BE REFUNDED.
Exception: All Home Based Programs requires a minumum $650 tuition payment plus shipping and handling prior to program. The LNC Center will allow all students FULL credit toward another seminar, if student cancels one day before class begins. Home based students may also transfer to class training from Home Based, with small transfer fee.
I have read the above and agree to the terms. To the best of my knowledge all answers above are correct and true.	Yes
Digital Signature:
Did I purchase the programs online using Paypal?	Yes No
If Mailing payment or deposit checks must be mailed to: Legal Nurse Consulting Center, (address above) or credit card payment is available on line from our website at www.lnccenter.com. (REMAINING BALANCE TO BE PAID BEFORE LNC PROGRAM COMMENCES) Please telephone us 1-888-888-4560 if assistance is needed.