Course Registration Form

Please print this registration form and then mail, fax or phone in your registration to: 

Human Resources Institute, LLC
151 Dunder Road, Burlington, Vermont 05401 USA
Phone: 802-862-8855, Fax: 802-862-6389
Email: Info@healthyculture.com

Once your registration is processed, we will send you login information for the complete course.

 Payment Method
A check is enclosed payable to Human Resources Institute, LLC

VISA      MASTERCARD

 

Credit Card Information

Name on Card

Credit Card #

Exp. Date

Billing Address

City

State

Zip

 

 Product Name

Quantity

Price

Total

Wellness Leadership Training

 

 $95.00

 


Signature:____________________________________________

Date:_____________________________

Thank you for your order!

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