CEU Registration Form

Step One

First Name

Last Name

Address

City

State

Zip

Email Address

Phone

Professional Certification

ABC Cert#

BOC Cert#

Course Selection:

Course

Fee

Course

Fee

Course

Fee

Please List your free Course's if Applicable

Method of Payment

Credit Card

Personal Check

Company Check

If you wish to mail a check. Make payable to Foot Solutions, mail registration form and payment to: Attn: The Academy of Pedorthic Science 104 Interstate North Parkway East, SE Atlanta, GA 30339 Phone: 678-498-2977

If you are paying by credit card, use the payment button below to complete the registration after you have submitted the form.

Step Two

In order to complete your registration, after you have submitted the form, please enter your name and select the pay now button. On the next screen you will enter the total amount owed for registration of all the courses you selected.