Manual Registration Request Form
Today's date:
June 19th, 2024
Select Course:





Promo/Discount Code:
Student Information
First Name:
Last Name:
Email Address:
Billing Information
Name On Credit Card:
Credit Card Number:
 (no dashes or spaces please)
Credit Card Expiration Date:
C/C Security Code (CVV2):
Billing Address:
City, State, Zip:
Telephone:
I, , am an authorized user of the above-referenced credit card and hereby authorize CPRToday! Inc. to charge said credit card in the amount of $.
Your request for registration will be processed as promtly as possible. You will then receive your log-in instructions along with your payment receipt.