Registration: Supplemental Course

Training

Name *

First

Last

Email *

Primary Phone *

Secondary Phone

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Languages *

Languages / dialects you speak well and for which you would like to interpret

Are you currently an interpreter ? *

Yes
No

Have you taken basic medical interpreter training ? (Pre-requisite) *

Yes
No

I would like to pay *

full amount in advance: $200
$50 down, with balance prior to completion of class

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