Student Information

Student Name*
Student Email*
Cell Phone*
Agency*
Address*
Training Manager's Name
Training Manager's Email
Training Manager's Phone

Course Information

Course Title*
Location and Date

I understand that classes may be cancelled at anytime due to unforeseen circumstances. This can include, but is not limited to, low course registrations, natural disasters, classroom availability and other unforseen circumstances. *
Substitution Policy: Graves & Associates encourages you to make a substitution if a student cannot make it to the course; substitutions will be accepted prior to the course and on‐site. Substitutions must be made in writing when prior to the course and noted correctly on the roster on-site. *
Registration Policy: Graves & Associates will not register anyone for a class unless payment has been received in full. If you are not able to provide payment up front you may provide a credit card to hold the seat. However, all students must be paid in full by 10 days prior to the class, if payment is not received at that point and a card has been given to hold the seat, it will be charged. *
Cancellation Policy: All cancellations and refund requests must be made in writing. All cancellations are subject to a $15 administrative fee. There will be no refunds or cancellations received 15 days or less prior to the start date of the course. Refunds will not be given for no-shows. (1)*

Payment Information

Course Cost*
Number of Attendees*
Total Cost*
I understand that a 4% processing charge will be applied to all credit card transactions. *
Credit Card Authorization
List Additional Attendees
Card Holder Name*
Credit Card Number*
Expiration Date*
Security Code (CVV)*
Billing Address*
Billing Zip Code*
Type Your Name for Digital Signature*
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