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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 Home-Study/Online Courses
(Use the Seminar/Workshops Registration form for the live seminars)

THE CATALOG OF HOME-STUDY/ONLINE COURSES WITH DISCOUNTS, PRICING & REFUND POLICTY (In case you haven't looked yet)


 

YOU MAY ALSO CALL US AT 800-435-3131 TO REGISTER, IN LIEU OF THIS FORM
or PRINT this form and fax to 01-305-946-0232, or just SUBMIT electronically below.
Once you have registered you will receive an email confirmation and directions. You'll set up your own password online with the email address you provided to us.
Course Manual and Slide Handouts are available as a download from the first slide in the first module of the course. Just click to download.

"*" Indicates required information         REGISTER BELOW:

*Name
 -- as you would like it to appear on the Certificate, including "RN", "MD" etc.
    (additional students will be listed in a field lower down on this form)
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
*Home-Study/Online Course Name



  
 




Choose the Correct Home-Study/Online Course
If you select the 2+ persons option, enter them in the box below. You can also just call us later with the names & emails. If you buy the one person program, you have 30 Days to add the second person for the discounted price.
Additional Students for the Programs:
Please list their names as they should appear on Certificates, and a unique email to set them up. 
You can also call our office to add later

Up to 5 total are included in the "2+" Course Selections. Past the initial 2, an additional fee of $125 pp will apply.

  		LIST NAME AND EMAIL OF ANY ADDITIONAL STUDENTS:
REMARKS OR REQUESTS?     

*Payment Method:

*Enter either Purchase Order # or Credit Card Info
(no online authorization nor materials will be sent until payment is rcvd)
no payment information is required for the "FREE PREVIEWS"
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 or online modules accessed..
                                                                 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 a day.  Call us at 800-435-3131 if you don't.

"*" - Denotes Required Information