PRIORITY HEALTH EDUCATION

ASTEP REGISTRATION FORM

Please use this Registration Form to register for all ASTEP Education programs. Your deposit (20%) or full tuition can be paid via credit card directly on the registration form. If paying by check, please send your check to:

Priority Health Education
PO Box 3267
Chester, Virginia 23831 USA

If paying by Pay Pal please complete the registration form and then select the Pay Pal Logo below or under the Registration Tab.

Acceptance Criteria

High School Diploma, GED, or International Equivalent. (We DO NOT need a copy. By signature of this Agreement you declare compliance with these criteria.

Obtain American Heart BCLS Certification. (The cost of meeting these criteria is not included in the program tuition.)

Have a thorough understanding of the English Language.

School/Training Environment

Didactic, Practical, and Clinical training will be accomplished by spending appropriate time in a class room and/or lab environment.

Student must not be overly disruptive, combative or excessively argumentative. The instructor retains the right to have such a student vacate the premises and/or removed from the program without recourse or rebate.

Training hours will vary to meet the scope of the program. This may include both daytime and evening hours and sometimes may require homework.

Students will participate in interactive role playing as necessary, as both patients and technicians.

Proper dress code must be adhered to at all times. Business Casual (no Tank Tops, Flip Flops, etc)Shorts are acceptable with proper top and shoes. Hospital Scrubs (in good repair) are acceptable.

Students must arrive to class on time or risk being denied access to that days lessons. This could result in not meeting Program Completion Requirements.

Work Environment

The work environment characteristics described here are representative of those a student encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

In the performance of this job, the student may be exposed to chemical vapors such as acetone, ether, or gluteraldehyde.

There may also be skin contact with these substances.

The student may also be exposed to infectious agents including blood-borne pathogens.

Please complete this form in its entirety and then submit to Priority Health Education. By submitting the form you agree to all the terms for class participation including attendance and completion requirements.

First Name: *
Middle Name / Initial:
Last Name: *
Home Address 1: *
Home Address :
Home City: *
Home State: *
Home Zip: *	(5 digits)
Country: *
Primary Phone: *	HomeCellWork
Secondary Phone:	HomeCellWork
Email: *	WorkPersonal
Email:	WorkPersonal
Employer (optional):
Work Address 1:
Work Address 2:
Work City:
Work State:
Work Zip:
Work Country:
Class Location:	Ft LauderdaleRichmondSlidellStarkeville
Other Class Location:
Start of Class: *
Payment Method:	Master CardVisaDiscoverAmexCheck
	Pay Pal (Complete Pay Pal Payment on the Registration Page)
Payment Amount:	Deposit (20%)Full TuitionOther
Credit Card Number:
Expiration Date:
CVV Code (3-digit number on the back of the card or 4-digit number on the front of Amex):
	Registration is only secured by a minimum deposit of 20% tuition or by payment in full via check or credit card. Priority Health Education reserves the right to terminate the enrollment if tuition balance is not paid in full 15 business days before scheduled course date unless other arrangements have been made. Cancellations made within 30 days of course start date may result in the loss of the 20% deposit. Substitutions of scheduled individuals are allowed up to 5 days before scheduled start date. PLEASE WAIT UNTIL YOU HAVE RECEIVED WRITTEN CONFIRMATION OF YOUR REGISTRATION BEFORE FINALIZING TRAVEL PLANS.:
	By submitting this registration I certify that I have read and understand all points listed in the registration documents. I authorize Priority Health Education to register me for this class and to process payments. If the name or address of the credit card owner is different from the registration name or address please provide the credit card owners name and address in the comments section BELOW.
Promotion Code (if applicable):
Comments:	Enter comments here!

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ASTEP REGISTRATION FORM