Registration Form:

  

 

Last Name             

First Name             

Daytime Phone #          Evening Phone #   

Current Address:

Street:                            Apt:

City:                                 State:         Zip Code:

Do you have a high school diploma or GED:

Yes No

Program of Interest:

Medical Assistant         

Patient Care Technician  

Certified Phlebotomy Technician   

Certified EKG Technician

Phlebotomy and EKG Technician       

Phlebotomy Technician/ Medical Terminology/ First Aid and CPR

EKG Technician/ Medical Terminology/ First Aid and CPR

Medical Terminology               

Medical Terminology with Anatomy 

Medical Terminology for Medical Interpreters

Medical Billing and Coding                              

First Aid and CPR         

CPR for Professional Rescuers                           

Ergonomics

Slips, Trips and Falls

Back Injury Prevention

Workplace Violence Awareness

Your Heart Matters

Managing Stress

 

Methods of Payment:

Cash Check Credit Cards

 

When Do You Want To Start Classes?

 

How did you know about ANDO:

Company      Friend     Newspaper     Other

email:                    

Comments:            

              

 
Copyright: Ando Medical 2005