STUDENT REGISTRATION

Students - Any person or individual that purchases a course for themselves.

Innovative CEUs, LLC
61 N. Plains Industrial Road, PMB 387
Wallingford, CT 06492
877-817-0230

* GENDER
* FIRST NAME
* LAST NAME
* EMAIL
 
* COUNTRY
PASSWORD
Passwords must be between 6 and 9 characters in length.
Passwords must contain at least:
1 UPPERCASE Letter
1 lowercase Letter
1 Number
* PASSWORD
* CONFIRM PASSWORD
GENERAL INFORMATION
* ADDRESS 1
ADDRESS 2
* CITY
* STATE
* ZIP
* How did you hear about us?
PHONE NUMBERS
* At least 1 phone number is required. (The one checked as primary)
Check the radio button to indicate which number is your primary number.
HOME PHONE (primary) - -
OFFICE PHONE (primary) - - Ext.
CELL PHONE (primary) - -
CREDENTIALS
* PRIMARY STATE
LICENSE
* I have read and accept the Terms & Conditions
* I have read the Site Disclaimer Policy
* I have read the Privacy Policy