Registration

Personal Information
Name*
First Last
Address*
Street Address City State Zip
Phone*
Email*
Date of Birth*
Gender*
High School Information
Diploma Type*
Year Issued*
Place 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 the red SUBMIT REGISTRATION bar below.

Columbus Phlebotomy
Training Center, LLC