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Enrollment Form
Required Items. Please read the cancellation policies.
Course Information
Course:
Communicating with Families: Empathetic Communication
* Course Date::
Cost of Class:
$199 per Student  
* Number of Students Required:

Discounts:

  

EBD Deadline is for those students who pay on or before 3 weeks of training date listed above. When registering online, Early Bird Discounts are only available with Credit Card registrations! 

 
Total Cost:
Contact Information
* Contact Name:

* Job Title:

* Company:

* Email:

* Phone:

Fax:

Address:
Additional Students
Fill in the following fields depending on how many seats you require.
1st Student Name:
1st Student Email:
2nd Student Name:
2nd Student Email:
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 the cancellation policies.
Course Date::
Billing Information
* Method of Payment:
PO#

 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.

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

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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.

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