Basics Feb 2025 Reg

Complete the form below to register and pay online for the Credentialing School: The Basics.

Registration Free $2,495, Two or More: $2,245 each

*Please complete all fields.

You are registering for:*

February 2025

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Virtual Class Dates: February 24, 26-28 and March 3, 5-7, 2025

You may use this form to register up to 5 people at one time. If you have more than 5 you may use this form again or contact our office via email or phone (719) 574-6016.

Have you attended one of our Credential Schools: Hospital Basics classes in the past five years?*

No, this is my first time.

Yes, I am a returning student.

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Welcome back! As a returning student, you qualify for half-off one registration. To receive this discount, enter ComeBack25! into the Returning Student Discount box below. Please note: If you are registering more than one returning student, you must register each returning student separately in order to receive the discount.

Returning Student Discount

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Total ($)

0.00 USD

Registration Details

Note: Registration confirmation will be sent to the email address provided in this section. Be sure you have entered a current, correct email address before submitting the form.

First Name*

Please let us know your name.

Last Name*

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Your Email*

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Phone

enter a valid phone number in this format 123-456-7890

Fax

enter a valid phone number in this format 123-456-7890

Title

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Company/Organization

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Organization Type

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Name of Healthcare System (if applicable)

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Number of Medical Staff (Physicians)

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Months/Years of experience in credentialing

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Street Address

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City

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State

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Zip

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Please provide the requested information about the additional attendee that you are registering.

Please provide the requested information about the additional attendees that you are registering.

Attendee 2 Information:

Attendee 2 Full Name

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Phone

enter a valid phone number in this format 123-456-7890

Please provide an email address.

Title/Position

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Fax

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Months/Years of experience in credentialing

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Attendee 3 Information:

Attendee 3 Full Name

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Phone

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Title/Position

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Fax

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Months/Years of experience in credentialing

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Attendee 4 Information:

Attendee 4 Full Name

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Phone

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Please provide an email address.

Title/Position

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Fax

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Months/Years of experience in credentialing

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Attendee 5 Information:

Attendee 5 Full Name

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Phone

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Title/Position

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Fax

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Months/Years of experience in credentialing

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Payment Options

Select Payment Type

Credit CardPay Later (Invoice me)

Payment Details

Please complete payment details. Your payment will be processed through our secure online payment processor.

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First Name

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Last Name

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What is the billing zip code for this card?*

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Card Number*

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Security Code*

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Expiration Month*

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Expiration Year*

Card expiration year required.

NOTE: An invoice will be generated and emailed to you after you submit this form. Be sure you have entered the correct email address above. If you would prefer to pay online now, please select the "Credit Card" option above.

Review and Submit

Review your submission above to make sure you have included as much information as possible. If all is correct, check the recaptcha and submit the form. Once you submit the form your payment will be processed by our secure payment processor.

Cancellation/Refund Policy: All cancellations must be made in writing. Cancellations received at least 21 days prior to the course are eligible to receive a refund, less a processing fee of $250 per registrant.

February 2025 Basics Class Registration

Registration Details

Payment Options

Payment Details

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