CMT Registration Form
Fill out the form carefully for registration
Student Name
*
First Name
Middle Name
Last Name
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
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31
Day
Please select a year
2025
2024
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2022
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2015
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1927
1926
1925
1924
1923
1922
1921
1920
Year
E-mail
*
example@example.com
Mobile Number
*
Phone Number
Work Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Courses
*
Please Select
CMT 20 Hour (New)
CMT 20 Hour (Expired)
CMT 4 Hour Refresher
Course Selection
*
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( X )
CMT 20 Hour Course - New
$
275.00
Quantity
1
2
3
4
5
6
7
8
9
10
CMT 20 Hour Course - Expired
$
280.00
Quantity
1
2
3
4
5
6
7
8
9
10
CMT 4 Hour Refresher Course
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
ACH Bank Transfer
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Additional Comments
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