LSCI Online Course Registration:
Registration Instructions
(Registration is a 4-step process)

We accept checks,  most major credit cards and Agency purchase orders. 
See Pay Options for details. 
To pay online,   then return here to complete your registration by filling out the form below.

*Required

Course Session*:

Participant First Name*:

 
Participant Last Name*:  
Street Address*:  

City*:

 

State/Province*:

Country*:

  or 

 

Zip/Postal Code*:
Cell -    Country Code/Area Code/Phone:  
Work - Country Code/Area Code/Phone:  
Home  -Country Code/Area Code/Phone:*:  
E-mail*:  

Employer*:                   Location*:  

Current Position*:                  

I am taking this course for PLU credit*: Yes No

Payment Method*:                   

If using a purchase order:    Agency:  P.O. Number:

Social Security Number (for certification records only):

Certification/Licensure Area: