Certification Registration Form

  • No cancellation refunds will be issued after seven (7) days prior to the event.
  • Registration transfers are allowed up to the day of the event.
  • Registration (online or paper) must be received seven (7) days prior to the event!
  • Complete the PAY PAL forms, then complete the Registration forms...
  • Click the Submit button at the bottom of this form only once AFTER using Pay Pal.

PLEASE CHECK WHICH EVENTS YOU PLAN TO ATTEND

Consumer Directed Health Care Certification Course

Location: Savior Pastoral Center
12601 Parallel Pkwy
Kansas City, KS 66109

Date:September 17, 2010Registration:7:30 amTime:8:00 am - 11:55 am  

Check One: 

Fees: KAHU/KAIA is $145.00.  Non-Member is $170.00








Wellness Certification Course

Location: Savior Pastoral Center
12601 Parallel Pkwy
Kansas City, KS 66109

Date:September 17, 2010Registration:12:30 pmTime:1:00 pm - 3:00 pm

Check One: 

Fees: KAHU/KAIA is $70.00. Non-Member is $80.00








Registration


Name:


SSN (for CE Credits)


Address:


City:StateZip


Phone:Email: 

State Insurance License # (Required)       


Registration is not complete until the Submit button has been clicked.



CDHC Certification
Wellness Certification
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Not Attending
Attending
Not Attending