CAPPA CLE Registration Form
Fill out the form carefully for registration
Name
*
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address
*
example@example.com
Mobile Number
*
Are you a birthworker?
*
Please Select
Not yet,
Yes, Doula
Yes, Midwife
Yes, Nurse
Yes, Other
Company
Additional Comments
Class Time Runs 9-5 CST. Please select your time zone.
*
Please Select
I understand this is 7am-3om PST
I understand this is 8am-4pm MST
I undetstand this is 10am-6pm EST
Select Course Date
*
Please Select
Dec 5th, 12th, & 19th (Virtual)
CAPPA CLE Training & Certification
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CAPPA CLE Training and Certification
$
900.00
Quantity
1
2
3
4
5
6
7
8
9
10
CAPPA CLE Training and Certification Payment Plan
The total cost of training is $900. $450 is due at the time of registration with the remaining balance due 1 week prior to training. All payments are non refundable.
$
450.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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