Statewide Training Academy, Inc.    
"Excellence Through Training"




ONLINE REGISTRATION



ONLINE REGISTRATION FORM:

    NOTE; YOU NEED TO HAVE THE EXACT DATE OF
    THE COURSE YOU WANT TO ATTEND,
WRITTEN
    DOWN, IN ORDER TO COMPLETE THIS FORM!

                     

 
Enter the DATE of the Course you want to attend:
(ENTER only the first date of the class if
your course is held over multiple days.)

First Name::
Middle Initial::
 Last Name::  
   
   
 Social Security # (last 6 digits)::  
ie. XXX-12-1234
Street Address::
City::
State::
Zip Code::
Your Phone #::  
ie. 512-444-8888 (include Area Code)
Alternate/Mobile Phone #::
ie. 512-444-8888 (include Area Code)
   
   
 Emergency Contracts Name::  
Emergency Contacts Phone::
   
   
 Employers Name::  
Employers Phone (optional)::
   
   
 Which Course?:
Which Academy?:
Payment Method::
Type of Credit Card::
Credit Card #::
(ie. 1234-5555-3232-9898)
Expiration Date::  (ie. 06/2011)
CID#::  
(3 digit code on back of Visa/MC/Discover,
 4 digit on front of AMEX)
   
   
Billing Address for Card::
(123 Anystreet Drive, City, State)
 Billing Zip Code for Card::   
(ie. 77333)
   
   
YOUR EMAIL ADDRESS::  
How did your hear about the Academy?:

BY SUMITTING THIS REGISTRATION I AGREE TO PAY THE TOTAL AMOUNT FOR THE COURSE ACCORDING TO THE CARD HOLDER AGREEMENT.

IF YOU SECURED YOUR SPOT, BY PROVIDING A CREDIT CARD, YOU NEED TO BRING THE EXACT CREDIT CARD AND YOUR PICTURE I.D. TO THE COURSE. (FOR SECURITY AND VERIFICATION PURPOSES)

DISCLAIMER:  COURSES ARE NON-REFUNDABLE & NON-TRANSFERRABLE.  BE ADVISED, BY SUBMITTING A REGISTRATION FORM & PAYMENT INFORMATION YOU ARE REQUIRED TO ATTEND THE COURSE FOR WHICH YOU ARE REGISTERED.  NO REFUND OR CREDIT FOR A FUTURE COURSE WILL BE EXTENDED IF YOU ARE UNABLE TO ATTEND THE COURSE FOR WHICH YOU ARE REGISTERED.


   

   

         
THE ACADEMY DOES NOT ACCEPT PERSONAL CHECKS!

   

The Academy accepts CASH, Money Orders, Employer Checks, and all major credit cards.  Including Debit cards.  Secure PayPal payments can be submitted to the following verified email address:



SPECIAL INSTRUCTIONS FOR CUSTOMERS PAYING WITH PAYPAL:
Sending us a PayPal payment does NOT tell us which Course or Academy you want to attend.  Therefore, you need to make sure you complete the Registration Process.  This will be done as follows:

Make sure to select:
"I will pay with PayPal"  in the "Payment Method" drop down menu.  Make sure to CLICK the "Submit" button after completing the Form.  This will send us your Registration Form (but not your secure Credit Card information).  PayPal will bill your card, securely, and they will pay the Academy directly on your behalf.


How do you find your CID Number on your Credit Card: 

  AMEX CID (4 digits) 



Visa CID (3 digits)            



Mastercard CID (3 digits)