Registration Form

You Have two Options to fill the registration form:

1. Download the PDF file and fill it up and send it to us
2. Fill up the from Below and go step by step

Download The Registration Form here

Full Name

Date of Birth

Gender

Address

City

State/Province

Postal Code

Phone Number

I have a healthcare background. Current Profession (if applicable):

Previous Education or Certifications:

Enroll in the Pedorthics Certificate Program

Registration Fee: $150 (non-refundable)

Refundable Deposit: $1,000 (refundable upon program completion)

Total Due at Registration: $1,150

Acceptance

I understand that my spot will be reserved upon receipt of payment.

Payment Method

Credit/Debit Card Bank Transfer Check

Name on Card

Card Number

Expiration Date

CVV

Registration Deposit Refund Policy: The $1,000 deposit will be refunded only upon successful completion of the program.
Withdrawal Policy: The $150 registration fee is non-refundable.
Attendance Commitment: Students must commit to the full program schedule to receive certification.
Program Changes: The institution reserves the right to modify program content or schedules as needed.

Terms Acceptance

I have read and agree to the terms and conditions.

Applicant Information

Full Name

Date of Birth

Gender

Address

City

State/Province

Postal Code

Phone Number

Educational & Professional Background

I have a healthcare background. Current Profession (if applicable):

Previous Education or Certifications:

Program Selection

Enroll in the Pedorthics Certificate Program

Fees and Payment Details

Registration Fee: $150 (non-refundable)

Refundable Deposit: $1,000 (refundable upon program completion)

Total Due at Registration: $1,150

Acceptance

I understand that my spot will be reserved upon receipt of payment.

Payment Information

Payment Method

Credit/Debit Card Bank Transfer Check

Name on Card

Card Number

Expiration Date

CVV

Terms and Conditions

Registration Deposit Refund Policy: The $1,000 deposit will be refunded only upon successful completion of the program.
Withdrawal Policy: The $150 registration fee is non-refundable.
Attendance Commitment: Students must commit to the full program schedule to receive certification.
Program Changes: The institution reserves the right to modify program content or schedules as needed.

Terms Acceptance

I have read and agree to the terms and conditions.

Please complete the form below to register for our Pedorthics Certificate Program.

You Have two Options to fill the registration form:

Download The Registration Form here

Registration Fee: $150 (non-refundable)

Refundable Deposit: $1,000 (refundable upon program completion)

Total Due at Registration: $1,150

Applicant Information

Educational & Professional Background

Program Selection

Fees and Payment Details

Registration Fee: $150 (non-refundable)

Refundable Deposit: $1,000 (refundable upon program completion)

Total Due at Registration: $1,150

Payment Information

Terms and Conditions

Contact Information

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