Registration

Personal Information
Name*
First Last
Phone*
Address*
Street Address City State Zip
Email*
Date of Birth*
Gender*
High School Information
High School Diploma Type*
Place Issued*
Year Issued*
How did you hear about us?*
Program Selection
Please choose the course you would like to register for below.
Phlebotomy Technician Monday 6pm-10pm/Wednesday 6pm-9pm
Clinical Medical Assistant Monday 6pm-10pm/ Wednesday 6pm-9pm
Phlebotomy Technician Wednesday 12pm-4pm/ Friday 12pm-3pm
Clinical Medical Assistant Wednesday 12pm-4pm/ Friday 12pm-3pm
Phlebotomy Technician Saturday 8am-12pm/Sunday 8am-11am
Clinical Medical Assistant Saturday 8am-12pm/ Sunday 8am-11am
Once you have completed the registration form you must click SUBMIT REGISTRATION then click on the PAY PAL link to pay the Registration Fee. The registration fee is due when registering to hold your seat in the class.

Columbus Phlebotomy
Training Center, LLC