Consolidated
Learning ServicesConsolidated
Learning Services
7410 River Road; Fredericksburg, VA 22407
Pharmacology Course Enrollment Form
Please copy and paste this form into an email and send to info@learningsvc.com. There is a button at the end of the form to use Paypal and pay for this course. OR print this form and mail with your check or money order. We will not accept enrollment without payment. Materials will be sent to you when the enrollment form and payment is received.
Date: _________
Name: ________________________________
Address: ______________________________
City, State, Zip Code ____________________
Phone number where we may call you with any issues: ______________________
Email address which we will use to send assignments: _______________________
Do you hold any state licenses or state certifications? If so what state and type:
You must email this form to info@learningsvc.com or mail it to Consolidated Learning Services, 7410 River Road, Fredericksburg, VA 22407.
Please read the course policy thoroughly. You may pay for the course via Paypal