Ascension MA Registration Form

Please fill out the form below and submit it.

Have you ever taken a ProTrain/Ascension program before?*

YesNo

Full Name:*

First NameLast Name

Employee ID#:*

Personal Email:*

example@example.com

Primary Phone Number:*

Please enter a valid phone number.

Physical Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Program Name:*

Start Date / End Date (If minimum enrollments are not met for a private cohort, enrollments will be moved to the next national cohort typically beginning one week later)*

Current Position:*

Current Leader:*

Current Leader Email Address:*

example@example.com

Book Format Preference*

All Physical Books (Student is responsible for $65 Physical Book Fee if this option is selected)eBook Textbook + Physical Workbook

List Specialty*

List Other*

Course Materials Information:

The Medical Assistant course includes eBooks.

If you prefer to have all physical books, please select Yes on the question below. The student is responsible for paying the additional cost.

If you have an accessibility request for physical textbooks, please refer to this page for more information: https://protrain.edu/accessibility-statement/

I am interested in the all physical book option, please send me more information about the additional cost.

YesNo

Payment Method*

Credit CardCheck/Money OrderAscensionOther

Course Refund Policy:

Refunds for live online courses are only given under the following circumstances, by signing this form you are acknowledging your understanding of these policies:

There can be no refund for the course, once the first class has been concluded; or if any course material, including the eBook, is accessed. If extenuating circumstances exist, case by case situations will be reviewed by ProTrain. If a refund is issued, the refunded amount (- a $25 processing fee) will be dependent upon books being returned in excellent condition (i.e. no writing, missing pages; ripped or damage to pages and/or binding).

Please sign below to state that you have read and agree to the aforementioned refund policy.

Signature:*

Date:*

Date

ELECTRONIC SIGNATURE

The parties stated herein agree that either a digital signature or scanned images of such included here, of the authorized agents of ProTrain, LLC, and Student, shall be construed as to be the same as if this agreement was signed in-person with both parties present.

For more information, visit our website:
https://ascension.theknowledgebase.org

Call: (844) 292-8641 or Email: ascension@protrain.edu

Company: