CFS Allied Health Education / Tenderfeet Shoes

Class Registration

Last:

First:

Street:

City:

State:

Zip:

Phone: Fax

Email:

Credit Card #:

Name on Card:

Expires:

Security Code (on back):

CC Billing Address:

CC Billing ZIP:

Total amount authorized to charge on CC:

By submitting this form, I understand that I am not guaranteed a seat in the class selected until payment has been processed and the registration is confirmed. You will be contacted via phone or email for conformation of your registration within 48 hours. I also understand that if I choose not to return the fitting kit within 14 days, this card will be charged an additional $250.

I Agree

Class Selection

ABC CFTS 1+1 Class ($295) Date:

ABC CFTS Distance Learning Program ($295)

Promo Code:

I am interested in a private class at my location. Please contact me!

Comment: (List additional students here)