Home	SOUTHWEST HEALTH PROFESSIONS EDUCATION CENTER, INC.   Continuing Education Registration Form

Titles are active links to the web brochures for each continuing education program.
Titles in black indicate continuing education program details are not yet available.
Please check back at a later date. Website is continuously updated.

To Register: Fill in the form at the end of this page, being certain you have checked the program(s) you
want to register for. Fax or mail completed registration form to us with registration payment. No need to
include copies of detailed brochures with your registrations. Program seating is limited. Registration is not
complete until payment is received. Payment may be made by check or credit card (Mastercard, VISA, or
AmericanExpress). Confirmation letters will not be sent.

Fax to: (928) 776-6137  or  Mail to: SEC (OP SEC); 500 N. Highway 89; Prescott, Arizona  86313-5000.

Refunds: There is a $15.00 processing fee if course is cancelled at least 3 days prior to the program. 
No refunds will be made after that date.  A $20.00 processing fee will be charged on all returned checks.

We value your patronage, and appreciate your input. Comments are helpful to our continued improvement!

Thank you for choosing Southwest Education Center for your CE needs.

Last         First    MI 
Address
City        ST   Zip
Daytime Phone             e-mail
Private Sector     
Full Time VA Employee    VA Station Code  Mail Routing 
                                      
Last 4 Social Security or Tax ID#  Degree  
Job Title  Professional License #  

Registration Payment Due$___________________
Pay by Check     Credit Card: Visa   Mastercard   American Express

Card # _____________________________________    Exp Date: _______

Signature:____________________________________________________