Legal Name:

Address:

Phone:

Facility Name (if applicable):

Training and dates you plan to attend:  (Core or Continuing Ed.)

If you would like  E-mail confirmation, please provide E-mail address:

An ALF Administrator's Guide is available. Purchase is optional; however, if you are planning on taking the test (Core Training only), it is highly recommended. Administrator's Guides are available at the training for those who pre-purchase them as part of registration. Core Training: $350.00, manual included; Continuing Education Training: $75.00 a day, PLUS $25.00 for the Law and Rule Manual.

Training/Registration Fee: 

Guide/Manual Fee :

TOTAL AMOUNT:

(NOTE: Only Paypal Payments or Money Orders will be accepted,
payable to Beverly Bates, RN Consultant)

Complete this Registration form with appropriate fees ONE WEEK PRIOR to training start date.

PLEASE NOTE: No fees will be refunded if this office does not receive written notice of cancellation five (5) business days prior to the start of training. Fees paid for training missed will not be applied toward any future training. 
SORRY NO EXCEPTIONS.