Registration—IV Form - American Academy of Phlebotomy Technicians

Training - Intravenous Therapy Course

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Desired Weekend*

Intravenous Therapy for Allied Health Professionals*

Price:

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Profession/Job Title*

Emergency Contact Name*

First Last

Emergency Contact Phone*

Total

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PLEASE NOTE: Payment is to be made via Credit Card; once you submit your application, you can select the drop down for PayPal or Credit Card. If you prefer to pay by no credit-check financing, you are welcome to do so. Simply submit your application and contact our office to arrange payment.