LNC EDUCATIONAL CENTER

7810 BALLANTYNE COMMONS PARKWAY, #300

CHARLOTTE, NORTH CAROLINA 28277

PHONE: 704-319-5516 / FAX:  704-319-5517 / EMAIL: information@lnccenter.com

 

 

LEGAL NURSE CONSULTANT CERTIFICATE PROGRAM APPLICATION

 

Name: ______________________________________ Date: _________________

 

Address: ___________________________________________________________

 

City: ______________________________State___________ Zip: _____________

 

E-Mail Address: __________________________  Phone: ___________________

Necessary for examination purposes only.  We will never share your name, address, phone, or email address with anyone nor ever send you any unwanted solicitations.

 

Nursing License: _________ License in good standing w/Board of Nursing?: Yes    No  

 

Nursing Specialty (or Area of Practice): __________________________________

   
VIP Basic Program (Coupon Applied) _____$2450
Home Based Program (Coupon applied) _____$2450
Home Based 4 Part Payment Program _____$2600
VIP Gold Program (Coupon Applied) _____$3400
VIP Platinum Program (Coupon Applied) _____$5400

 

_____City of Seminar_______________________    Date__________________

                 OR

_____HOMEBASED

 

CANCELLATION POLICY: Full refund (minus $100 Registration Fee) with 7 or more days notice. IF CANCELLATION OCCURS 6 DAYS OR LESS, prior to the classroom program, YOU MAY RECEIVE FULL TUITION CREDIT TOWARDS A FUTURE PROGRAM OFFERED, NO MONIES WILL BE REFUNDED.

All Home Based Programs requires a minimum $650 tuition payment plus shipping and handling prior receiving the LNC Program.

The LNC Center will allow all students FULL credit only applied towards 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 to the classroom, if available.

_______ I have read the above and agree to the terms.  To the best of my knowledge all answers above are correct and true.

 

 

 

Signature__________________________________________________________________________

 

 

Payment enclosed ____________ REMAINING BALANCE MUST BE FULLY PAID WITHIN ONE YEAR.

Students in the 4 Part Payment Plan: Every 3 months, a $650 payment will be due and owing. However, students may opt to request to pay earlier than every 3 months. All LNC payments must be completed prior to sitting for the ASLNC Cert. Exam .

All applications and deposit checks must be mailed to: Legal Nurse Consulting Center, (address above) or credit card payment is available online from our website on the Online Payments page.

Please telephone us 1-704-319-5516 if assistance is needed.