Manual Registration

Welcome to our 'Manual Registration Page'... Please complete and submit the following form. This information will not be sent to Paypal, it is forwarded directly to MECA. Thank you! After submitting this form, your will be redirected to a registration confirmation page. You will also receive additional instructions on how to finalize your registration.

Email Address :
First Name:
Last Name:
Address:
City, St. Zip:
Day Telephone '000-000-0000':
Evening Telephone '000-000-0000':
Pager or cell phone (same format):
Employer:
Professional License Number:
Course Attending:
Course Start Date '00-00-06':
Course Location:

Company Cancellation Policy In the event of a natural or manmade disaster, the registered participant may elect to choose another course date within the next twelve (12) months from the original training date or substitute another participant to take their place 72 hours prior to class without penalty. Cancellations for disasters will not be refunded. Refunds may be granted due to a death or severe illness within the participants immediate family with documentation and written notice postmarked prior to course date. A $75.00 administrative fee will be withheld. There will be NO REFUND for "no shows" which do not adhere to this policy. Refunds will be sent within 4 to 6 weeks from date of written cancellation. If you agree, type "YES" in ALL CAPS, without the quotes here...