USE YOUR BROWSER BACK BUTTON TO RETURN TO THE PREVIOUS PAGE,
   OR HOME TO GO TO THE TOP OF THIS WEBSITE.

PROFESSIONAL MEDICAL EDUCATION ASSOCIATION, INC.
USE THIS PAGE TO ELECTRONICALLY REGISTER FOR COURSES.
Checks are made to Professional Medical Education Assn, and mailed to PO Box 997, Grove City, OH 43123
You may also Print Out and Complete this form, then mail to the address above or fax to 305-946-0232

Electronic Registration form - all Seminars/Workshops.
(Use the Home-Study/Online Registration form for those programs)

REFUND POLICY   - Please read this policy prior to registration. Laser Repair and some other small classes are noncancellable and nonrefundable. 

REVIEW THE SCHEDULED SEMINARS/WORKSHOPS ON OUR SCHEDULES PAGE (If you haven't already)
You'll receive an email confirmation within about one business day of your registration.
Course materials will be sent to you electronically via a "You-Send-It" email.

"*" Indicates required information

YOU MAY ALSO CALL US AT 800-435-3131 TO REGISTER, IN LIEU OF THIS FORM,
                                                              or PRINT this and fax to 305-946-0232

*Name
 -- as you would like it to appear on the Certificate
Title/Dept.
Company / Hospital
 *Work Address Preferred
Home address OK

 

Home or Work address and phone?

*Registrants E-mail
Confirmation, and ALL course materials and online authorizations will be sent electronically via email to this address, in addition to any course status updates.


*Phone
*Course Name

   
 



Choose the Correct Course
PLUS - type in the course date & city below for clarification:
*Type-in Course Date & City:
Add a copy of the current ANSI 136.3 Standards ? Yes, include the ANSI 136.3 for $155, plus $15 for shipping
(American National Standards Institute - Safe Use of Lasers in Health Care
     Facilities)

NCLE Laser Certification  :

visit www.LaserCertification.org for more information on this.
You can always call and add them.   

Do you tentatively plan on taking one of the NCLE Laser Certification Exams at the end of this course (if offered)?
Yes                  No

If Yes, which type of exam will you be taking?
call us if you want to take more than one exam.

*Payment Method:

*Enter either Purchase Order # or Credit Card Info
Purchase Order: #
Credit Card:

(Visa, MC, AX, Discover)

Cardholder: :
Card Number:
Expiration Date:      
3 Digit Security Code on Back:

See the "Refund Policy" before proceeding with checkout.  No refunds are provided once materials have been sent.
                                                                 Printable Version of the Refund Policy (pdf)

Privacy Policy

 By clicking the SUBMIT button below, you acknowledge that you have read the above listed refund policy and agree with its terms.
  
   You should receive an e-mail confirmation of your registration within one day.  Call us at 800-435-3131 if you don't.

"*" - Denotes Required Information 

*Note - The amount charged to your credit card will be the discounted price of the course fee (when applicable) as listed on the course information pages. The amount invoiced on a purchase order will be the full course amount, with a note indicating that the discount may be taken if payment is received by us prior to the course date. Call us at 800-435-3131 with any questions.