Preceptor Online Registration – Success Development Inc.

Choose a Class:

Attendee Name:

Attendee Title: (if applicable) (optional)

Attendee Home Address:

Attendee City/State/Zip:

Attendee Work Phone Number: (optional)

Attendee Home Phone Number: (optional)

Attendee Cell Phone Number:

Attendee Personal Email:

Attendee Work E-Mail: (optional)

Facility/Building Name: (if applicable) (optional)

Facility Corporation: (if applicable) (optional)

Facility Address: (optional)

Facility City / State / Zip: (optional)

Facility Phone Number: (optional)

Subtotal $299.00

Total Amount: $299.00

Registration Information!

Attendee Registration: By Submitting Payment.I certify, under the penalties or perjury, I have represented my identity and place of employment truthfully and that I am attending for the sole purpose of completing the course of study to meet state requirements to fulfill my Preceptor Course requirements and/or obtain CEU’s as required to maintain my current license. I further certify that I am not attending to engage in an investigation of this course, its speakers or its sponsors.

Confirmation Email: Once registration is submitted, you should receive a welcome and confirmation email within 48 hours. If email is not received, please contact us at (317) 596-0707 or success@successdevelopment.biz. Cancellation/Withdrawal/Incompletion: CANCELLATIONS MADE LESS THAN 15 WORKING DAYS PRIOR TO THE SCHEDULED SESSION OR “NO SHOWS”, ARE NOT ELIGIBLE FOR A REFUND. EACH SITUATION WILL BE REVIEWED FOR DETERMINATION OF REFUND OR CREDIT ELIGIBILITY. ($50.00 IS NONREFUNDABLE – IF A REFUND IS APPROVED) IF A SESSION IS CANCELED BY THE PROVIDER, A FULL REFUND WILL BE MADE. FOR ADDITIONAL CLARIFICATION, CONTACT THE COURSE PROVIDER.er. Assistance: Please let the Course Provider know if you need special accommodations.