EmailMe Form - Multi-Student Subscription

Multi-Student Subscription

Please use this form to request for a group subscription code. When we receive your request and payment, our office will send you your code and instructions that participants will use when enrolling in a class.

Laboratory/Agency Name: *

Contact Name: *

First Last

Contact Position/Title: *

Contact Phone:

### - ### - ####

Email *

Confirm

Laboratory Address: *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Select your Subscription Option

5 students............$2,220
10 students..........$4,115
15 students..........$5,610
20 students..........$6,545
25 students..........$7,015

Please select the number of students you would like for this subscription: *

Please enter the total amount to be billed:

$ Dollars

If you wish, you may opt to purchase multiple subscriptions. If so, please enter the appropriate amount to be billed and leave us a note in the comments box below.

Please select your payment preference: *

Credit card

Check by mail

Comments or questions:

After submitting this form, you will be directed to our main class page. Please follow the payment instructions for OPTION 3. You will also receive additional instructions by email. *

I acknowledge