Agency Management Resource Group

Education & Training Programs

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Registrant Information
Applicant First Name* Middle Initial
Applicant Last Name*
Organization*
Social Security Number
Street*
City*
State*
Zip Code*
Phone Number*  Ext.
Fax Number*
Email Address*
Licensed State 1*
Licensed State 2
Licensed State 3
Need for handicap assistance*
   
   

Agency Information
Agency Sponsor
Sponsor Phone Number
Sponsor Email Address
   

Course Information
Location*
Date* First Day of School
Fee $2400
   

Payment Information

Mail payment to:

Agency Management Resource Group
390 Big Ben Rd.
Lincoln, CA 95648
   
 

AMRG requests disclosure of a social security number in accordance with statutes and regulations for your state. This information is requested so that you can be properly identified and assigned credit for attendance at Continuing Education classes. Disclosure of your social security number is not mandatory, however failure to provide this information may delay or otherwise impede our ability to assign credit for the completion of such courses.

Cancellation Policy: A refund will be provided if written notification is received 10 (ten) business days prior to class or program start, subject to a $250 deduction for incurred expenses. Notification within 10 days of class start will be considered a "no show" and full tuition will be forfeited.  Substitutes are welcome and other programs may be available to avoid cancellation charges. AMRG reserves the right to cancel or reschedule any scheduled class. Airfare, lodging, and other travel expenses are the sole responsibility of the participant.

390 Big Ben Road, Lincoln, CA 95648 phone:1.916.645.9034 fax: 1.916.645.7076