Self-Paced Registration Form

Submitted by admin on Wed, 10/28/2009 - 10:44

Learning @ Amigos.Org logo
Registration form for Learning @ Amigos.Org self-paced, online courses.

Registrant Information
(first and last name)
Institution Information
Choose your organization's network affiliation.
(e.g., AR, AZ, NM, OK, TX)
(999)999-9999
(999)999-9999
Courses Available
For security purposes, Amigos does not currently accept credit card numbers on this form. Please fax us your account information, including type (Visa or MC), expiration date, and signature. Access to the course will be provided after payment is received.

Please send checks to:
Amigos Training Registration
14400 Midway Road
Dallas, TX 75244-3509

Please be sure you have authority from your institution to purchase Amigos training via this Internet form.