Register Here

1.  For fast service, call 1-800-514-1229 or 1-386-445-9573  and give your Credit Card information to one of our office staff.  We also accept payment by Paypal.  You will be sent your login name and a password by e-mail, usually within an hour after you register.Clinical Research Training Online, Inc.

2.  You can print this page, fill out all requested information and mail a check to:

105 Southlake Dr.

Palm Coast, FL 32137

REGISTRATION FORM

_________check here for Monitoring Clinical Studies -- cost is $999.00

_________check here for How to Conduct Clinical Trials -- cost is $700.00

_________check here for Statistics for Clinical Research -- cost is $900.00

Full name______________________________________________________

Job title ________________________________________________________

Company_______________________________________________________

Street Address__________________________________________________

City, State, Zip code______________________________________________

Phone (day)_____________________  Phone (evening)__________________

E-Mail address___________________________________________________

METHOD OF PAYMENT

_________Check enclosed (make payable to Clinical Research Training Online, Inc.)

_________Credit Card (provide the information below and circle the credit card choice)

Name of cardholder_________________________________________

Card Number ______________________________________________

Expiration date _____________________________________________

Signature __________________________________________________

           VISA            MASTER CARD           DISCOVER

How did you find out about our training programs??

     1.  INTERNET.  If yes, which search engine do you use?  GOOGLE   MSN    YAHOO   OTHER

     2.  REFERRAL:   who or from where ___________________________________________

     3.  CENTERWATCH ________________________________________________________