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Registration Form

Registration Form

* Indicates Required Fields
Full Name *
(as to appear on course certificate)
Professional Designation * (i.e. RN, LPN, GN, etc) License #
Program Dates
Home Address *
Apt / Unit #
City *
State *
Zip Code *
Employer's Name *
Home Phone *
Work Phone
Email *
Preferred Contact Method *
Home Work Email


Early Registration Discount:

Register early and save $$. To qualify for early registration, ITI must receive full payments 
10 working days or 2 weeks prior to each scheduled class date. 


Group discount: Additional 5% group discount for a group of 4 or more attendees from any facility, with early registration. Must register and pay with one check 2 weeks prior to each class. Mail registration forms and payment check to Infusion Therapy Institute, 551 Concord Lane,
 Des Plaines, IL 60016.  Forward questionds to inservice@infusioninstitute.com

Cancellation Policy:
Infusion Therapy Institute, Inc. MUST receive all cancellations in writing or by e-mail seven (7) days prior to the scheduled class. $60.00 processing fee will be charged for each cancelled class and for checks with insufficient funds. No refunds are issued for cancellations received within 7 days of the class or for no shows. Registration fee is transferable for another class or another participant.

Infusion Therapy Institute reserves the right to cancel classes if sufficient registrations are not received within seven (7) days of a scheduled class. You may opt to attend another class. If you decide not to attend an upcoming program, a full refund will be made within seven (7) days for cancellations by Infusion Therapy Institute.

Security Code *

 

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551 Concord Lane, Des Plaines, IL 60016
312 912 7006• 847 338 5445
Fax: 88 546 2455
Monday – Saturday 8:30 AM – 5:00 PM