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Registration Form for CBPS eLearning Class

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Credit card (Visa, MC, Discover, AMEX) and checks accepted. Please make checks (in U.S. funds drawn on a U.S. bank) payable to: TransparentRx.

Course Name:

Number of Attendees:

Attendee Information

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First Name: *

Last Name: *

Company Name:

Mobile Phone: *

Email: *

Address Information

Address (line 1): *

Address (line 2):

City: *

State: *

Country: *

Zip Code: *

Promo Code:

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If you have a promo code, you must enter it here AND click the "APPLY NOW" button.

Access to the training will be emailed to each attendee within one business day.

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