SOUTHWEST HEALTH PROFESSIONS EDUCATION CENTER, INC.

---

To Register:  Please print this page, check the program(s)  you want to register for, and complete information on form. Fax or mail completed registration form to us with payment. Registration is not complete until payment is received. Payment may be made by check or credit card (Mastercard, VISA, and Discover) Fax to: (928)776.6137  Mail to:  SEC (OP SEC); 500 N. Highway 89; Prescott, Arizona  86313-5000. Registration fees are on lower portion of each specific program brochure. Click program title to link to brochure.

NOTE: Titles in black indicate that program details are not yet available. Please check back at a later date.
Refunds: There is a $10.00 processing fee if course cancelled 3 days prior to the program.  No refunds will be made after that date.  A $15.00 processing fee will be charged on all returned checks.  Confirmation letters will not be sent.  Space is limited; please register early.

Last         First   
Address
City        ST  Zip
Daytime Phone             e-mail

Employment                                                       
Full Time VA Employee     VA Station Code                           Private Sector
Department of Defense     DOD Location           Job Title  
Social Security or Tax ID#     
License #                  
Degree or Designation:

Payment:  Amount Due$___________________
Pay by: Check or   Credit Card:   Visa    Mastercard    Discover

Card #                                                Exp Date:_______Signature: