Make your own free website on Tripod.com

Phlebotomy Training

Advanced Registration Form
Home | 80 Hour Phlebotomy License | Steps to Obtaining Your California State License | Schedule of Classes | Initial Registration | Advanced Registration

Wagner Training Institute

PMB 275

700 E. Redlands Blvd, Ste. U

Redlands, CA  92373

800 845-8353

Fax 909 795-4926

Registration Form

Please see schedule for upcoming classes

(Please print your name the way you want it to appear on your certificate)
 
Name:____________________________________
 
Address:__________________________________
 
City:_______________________Zip____________
 
Phone:___________________________________
 
Class Location:_____________________________
 
Class Date:________________________________
 
Signature__________________________________

 
Advanced 20hr. Phlebotomy Tuition $250.00
 
Cashiers Check #________________
 
Money Order#___________________
 
Check #________________________
 
Deposit $_______________________
 
Balence $_______________________
 
Date:___________________Sex(M/F)

Advanced Registration Form

If you are having any trouble printing this form, please click on the above link.