ENROLLMENT

FORM

Fill out the enrollment form to complete your registration and begin your course

Course Fee $250

All certificate courses are 3 credit hours and take approximately 40 hours to complete.

First Name

Last Name

Date of Birth

E-Mail

Address

City/Town

State/Province

Postal Code

Country

Course

Credit Card Number

Accepted Cards
Visa, MasterCard, American Express, Discover, JCB, Diners Club, EnRoute

Expiration

Card Code (1-4 digits on back)

By submitting this form you autorize AHA World Campus to charge your credit or debit card in the amount of 250.00 US Dollars as payment toward your program

I agree to Terms and Conditions and Refund Policy.

I acknowledge I have received a copy of the Institutional Catalog.

AHA World Campus
20 Ridgewood Lane
Hilton Head Island, SC 29926
(843) 290-5009