Registration – NMCBP Medical Certification Bridge

Date *

Name *

First

Last

Payment/Cancellation/Refund Policy Refunds & Transfers All deposits and balances for workshops are non-refundable and non-transferable. However, we understand that emergencies happen, so if you are unable to attend a workshop that you have paid-in-full, and you cancel with more than fifteen (15) days notice before a scheduled workshop, you may request to credit or transfer 50% of total workshop fee to another class or workshop within 12 months of request. If you cancel within fifteen (15) days of a scheduled workshop, you will forfeit your entire tuition. It is recommended that you purchase travel insurance, which can protect you by refunding monies paid if you need to cancel your trip due to an emergency. Travel insurance is very affordable and can protect you in other ways as well. Workshop Changes or Cancellations NMCBP reserves the right to cancel any workshop, limit class size, change class times or substitute instructors for those listed in the schedule. If a workshop is cancelled, students may choose to receive a full refund or may transfer – with no fee – to another class or workshop. If NMCBP cancels for any reason, all payments can be refunded. Participation Waiver Registrant acknowledges that registration and participation is voluntary, and that by registering for this workshop/class that he/she is solely responsible for any loss, damage or injury, including death, that may be sustained on the premises or any location where any workshop/class is being conducted. *

Yes I read and agree to the refund policy

I certify that I do meet the requirements for this bridge program *

Enter your email addrtess *

Applicant's Email

Enter your phone number *

Applicant's Contact Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Are you currently in the healthcare field? if yes what is your title?

Declaration

Checkboxes *

All of the information provided above is correct to the best of my knowledge. *

Signature *

What workshop are you interested in registering for? *

What date is the workshop you are interested in registering for? *

What state and city is the workshop you are interested in registering for? *

Select Workshop Dropdown Items *

Medical Certification Bridge and NHCWA Registration Form *

Card

Name on Card