Credit Card Registration Form
Food Safety Manager Class/Exam/Products

Public Agencies - Purchase Orders
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Credit Card Payment Only - Registration Information

Company Name (Use "SELF" if no company.) *

Phone Number (Area Code) + (Phone Number) *

Email (This is where a confirmation will be sent.) *

Email - Enter again to confirm *

Mailing Address *

City *

State *

Zip Code *

SELECT DATE/LOCATION: *

NUMBER OF ATTENDEES - Enter the number 1, 2 or up to 15 for the number of attendees in each box.

Quantity:

Every box requires a number from 0 - 15.

* 🛈

	Food Manager Class and Exam ($159.00)
	Food Manager Exam (No Course) ($109.00)
	Manager "Re-Test" Only (Did not pass previously. Includes class.) ($79.00)

Enter ALL the names of the people attending the class/exam. The number of names should match the total number of attendees in the boxes above. Use the + or - button to add or delete names.
(First Name | Last Name) *

+-

Note: Please bring a tablet or laptop computer to take the exam - no cell phones. You may rent a tablet computer, see below.

OPTIONAL PRODUCTS - Enter the number 1, 2, or up to 15 for the number of products in each box.

Quantity:

Every box requires a number from 0 - 15.

	Tablet Computer Rental (To take the exam!)($10)
	NEHA Spanish Food Safety Management Book (sent via US Mail) $59

Do you have a coupon or promo code? Coupons are ONLY available for the COURSE AND EXAM, not for exam only or re-test. 🛈

Current Total:

$0.00

Check here to agree to all purchase terms and conditions. * 🛈

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How did you hear about us? *