APPLICATION FORM

USE OPTIONS CALCULATOR

 

Please provide the following contact information:

use select/delete to erase box contents or reset the form

First Name
Last Name
DOB
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
URL

 

Choose one of the following course options:

(to customize your options   USE OPTIONS CALCULATOR

  Choose package options 120-hour Master (Full) course $480 120-hour Master (Waiver) course $285 60-hour Standard (Full) course $410 60-hour Standard (Waiver) course $225 40-hour-Junior course $340 Startup CD $199

Choose how you would like to take a course:

  Attending Correspondence Online*"ATTENDING", fill in boxes marked with asterisk 

                         Choose your room option I request room I have my arrangements I do not need room I have a special requirement I do not choose ATTENDING *

                       Choose your board options I choose full board I have my own arrangements I have a special requirement I do not choose ATTENDING*

                       Choose your payment options I choose full payment $1190 I choose advance fees $250 I have a special requirement I do not choose ATTENDING*

Choose one of the following payment options:

  Cash Credit Card Pan Pal Western Union Bank-to-bank transfer Money order

Choose currency for your payment:

  USD (US Dollad) CAD (Canadian Dollar) CNY (Chinese Reminbi) GBP (British Pound) TWD (Taiwan New Dollar) KOW (South Korean Won) JPY (Japanese Yen) EUR (Euro) Other

Please paste in your resume/CV:

 

Please type in you mailing address?

 

Please input any comments or requirements, if any:

 

Do you agree with TIELC Terms and Conditions?

  YES       NO