Smokers Treatment Center Registration Page

Smokers Treatment Center Registration Page

Courses to be purchased:

Course Name	Select Course(s)	Course Price
Tobacco101 (3 Hours College Credit )		$475.00 USD
Tobacco Certification (NAADAC Credential)		$1,500.00 USD
TobaccoSchool.com (Public Web Support)		$90.00 USD

Click here if you are a NAADAC member. (Receive a $100 USD discount on the Certification Course.)

NAADAC Membership Number

Discounts are available to Health Plans, Employers, Communities, Government Organizations, Universities and others qualifying for quantity discounts.
Please email fcollins@smokerstreatmentcenter.com with your inquiry about discounts.

Total Price: $ USD

WELCOME AND THANK YOU FOR CHOOSING OUR COURSES.

- To complete your transaction, please fill in the details below regarding your name, address, and credit card information.
Only VISA credit cards are accepted.

- Items marked with an asterisk(*) are required in order to process your registration.

Billing Details:

Title:

* First Name:

Middle Name:

* Last Name:

Company Name:

* Street Address:

* City:

* State / Province:

* Zip / Postal Code:

* Country:

* Phone #:

Fax #:

* Email address:

		Billing Details:
	Title:
*	First Name:
	Middle Name:
*	Last Name:
	Company Name:
*	Street Address:
*	City:
*	State / Province:
*	Zip / Postal Code:
*	Country:
*	Phone #:
	Fax #:
*	Email address:

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