LEGAL NURSE CONSULTING COURSE
REGISTRATION FORM
Register before February 1 and Save $200
Course Registration Fee: $2,495
Please mark which session you are registering for:
16SNU600AN: Gulfport, Miss.
16SNU600BN: Metairie, La.
16SNU600CN: Mobile, Ala.
16SNU600DN: Baton Rouge, La.
Mar. 5; Apr. 2; Apr. 30; May 21
Mar. 11; Apr. 1; May 6; Jun. 3
Mar. 18; Apr. 22; May 20; Jun. 10
Mar. 12, Apr. 23; May 7; Jun. 4
Name:
Street Address:
City/State/Zip:
Day Phone:
Email:
Cell Phone:
Employer:
RN License No.
For award of nursing contact hours
STATE:
Method of payment:
Total amount:
Check or Money Order payable to USA Center for Continuing Education
Please charge my:
Card Number:
Security Code:
VISA
MasterCard
American Express
Discover
Expiration Date:
AMEX code is 4 digits, all others are 3
/
(Month/Year)
Billing Address (required):
Signature:
Cardholder’s name:
Remit completed registration form to:
University of South Alabama
Center for Continuing Education
555 University Blvd. N. / AHE 232
Mobile, AL 36688
Fax: 251.460.7709
REFUND POLICY: All course fees will be refunded if written notification of cancellation is received at least 10 business days before
the course begins. All course fees will be refunded if course is cancelled due to low enrollments. No refunds will be granted once the
course has begun.
The University of South Alabama does not discriminate in its student and employment practices in violation of any applicable laws.
The University of South Alabama is an Equal Opportunity Employer - Minorities/Females/Veterans/Disabled. In accordance with the
American’s with Disabilities Act, please advise us when you register for the course if you have any disability that requires special
materials and/or services so that the appropriate personnel can be advised to arrange the needed accommodations.