Course Registration – American Institute For Healthcare Management

Registration Form

Please complete all sections of this form in CAPITAL LETTERS:

Course

First Name

Surname

Name as you would like it on your certificate:

Birth date

Nationality

Current Position

Institution/Organization

Postal Address:

Zip Code / Postcode:

City

Country

Office Telephone

Cell Phone

Email

Training Course Terms and Conditions

Upon receiving your course registration, we will send an email acknowledging receipt of your registration. Final course confirmation will be sent at least one (1) week prior to the start date of the course. We will only confirm a course when we have sufficient enrolment to conduct a viable course.

If you have not received joining instructions within 10 days of forwarding registration Form, please contact us by email.

I the undersigned, authorize the American Institute for Healthcare Management to use the personal data received through this registration form for purposes relating to its activities

Signed

Date