Managing Health Services Enrollment

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Enrollment Form

* Required Items. Please read cancellation and refund policies.

Course Information

Course:

Managing Health Services in Head Start and Early Head Start

* Course Date:

Cost of Class:

$325 per person

* Number of Students Required:

Discounts:

When enrolling online, Early Bird Discounts are available with Credit Card registrations only! Take 3 discount is for 3 or more students registering for the same course.

Total Cost:

Classes are occasionally cancelled. Please indicate if there is a second date in our schedule which may be acceptable to you. You will not be enrolled in this class without a confirmation by phone and/or email or fax. Please read cancellation and refund policies.

Course Date:

Student Information

* Name:

* Job Title:

* Company:

* Email:

* Phone:

Fax:

Address:

Additional Students

Fill in the following fields depending on how many seats you require.

2nd Student Name:
2nd Student Email:

3rd Student Name:
3rd Student Email:

Billing Information

* Method of Payment:

Card No.

Expiration Date

Authorizing Manager:

Check this box if your billing address is the same as your personal information.

Billing Address:

Additional Comments

Comments:

Need more information? Call 1-888-282-7817

We send out our schedule and occasional promotions. If you would rather not receive these messages, please check this box.

Please bill the company: letter of authorization or purchase order will be faxed to (901) 758-4036. I have read and understand the registration and refund procedures for HSU courses.

HSU provides a range of services to allow persons with disabilities to participate fully in educational programs and activities. If you desire support services, contact the student Access Center at (901) 758-4034.