Lactation Counselor Training Course

 

Registration Form


* - Required Field
   
First Name *
MI
Last Name *
Organization
     HOME ADDRESS
Address 1 *
Address 2
City *
State *
Zip *
Country
Contact Phone 1 *
   Ext:
                                     > International numbers in notes section please
Contact Phone 2
   Ext:
                                      > International numbers in notes section please
Email Address *
Fax Number
Continuing Education Credit
RN License #
RN License State
RD #
IBCLC # Exam Year:
CNM #
Titles:
   
Registration Information
Location:
 
Class Tuition
 
Regular Tuition (per Person)
    Regular Tuition
    Early Bird **
Group / Agency Rate Tuition ***
(per person - minumum 4 people from same agency)
    Regular Tuition
    Early Bird Tuition **
  Agency:
** Early Bird: An early registration discount of $50 is available if your
check or credit card information is received 4 weeks (28 days) prior
to the beginning of the training.
*** A group discount is available when 4 or more people from the same agency register and identify themselves as part of that agency. The group must be identified at the time of registration. Group discounts will not be given retroactively.
Application and Exam Fees
The Certified Lactation Counselor ® Exam is administered by the
Academy of Lactation Policy and Practice (ALPP)
 
    Certified Lactation Counselor Exam Fee (includes $20 Application Fee)
    Not taking the CLC Exam
Textbook
The Pocket Guide for Lactation Management will be used during class and for homework. Participants may share books. This text book can be purchased as you register, through our website, or from Amazon.com.
 
    Pocket Guide for Lactation Management
    No Pocket Guide
Additional 175 CEU Hours
Optional Additional 175 CEU hours (must be combined with full course and exam).
 
    Additional 175 CEU Hours
    No Additional CEU Hours
 
 
Notes:
 
Payment Information
 
We are unable to hold a place for you without payment or
a purchase order number.
 
First Name *
Last Name *
Organization
Address *
City *
State *
Zip *
Billing Phone
 Ext:
                                      > International numbers in notes section please
Billing Email
   
Payment Type
Credit Card #
Exp (MM/YY)
Verification # (Printed number on Credit Card ***)
   
PO# (if PO)  
$25 per person surcharge for POs or to invoice / bill your agency for the whole or any part of this training and will be added for split payment.
   
  -

***The VCode is the 3 digit number on the back of your MC/VISA/Discover, or 4 digit number on the front of your AmEx.

 
                   
                   
                   
 
Phone registration number: (508) 888-8044
FAX registration number: (508) 888-8050
www.healthychildren.cc