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Participant First Name * | |
Participant Last Name * | |
Participant Email * | |
Participant Company | |
Participant Phone 1 * | |
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Name on Card (if different) | |
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Street Address 1 * |
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Street Address 2 |
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City * |
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State * |
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Postal Code * |
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Country | |
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Card Type * | |
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Card Number * |
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Expiration Month * | |
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Expiration Year * | |
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CVC * |
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By entering your initials and registering for this course, you acknowledge that your spoken questions or public comments during the course may be recorded, copied, transcribed, and distributed by The Shift Network and consent in advance to these uses.
This course is for educational purposes only. Neither the course leader nor The Shift Network is liable for possible damage incurred as a direct or indirect consequence of using the contents, advice or interpretation thereof. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care providers with any questions you may have regarding a medical condition or treatment and before undertaking a regimen, and never disregard professional medical advice or delay in seeking it because of something you have learned in this course or on our website.
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I have read and understand the terms of this agreement. |
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(Enter your initials) |
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