How many people are you registering? * 1 2 3 4 5 6 7 8 9 10 (including yourself) Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Continue". MHFA Registration First Name: * Last Name * Email: * Phone xxx-xxx-xxxx * Zip Code * Employer: Job Title/Occupation: Event Fee: Course Registration Fee * Registration Fee - $ 0.00 CEU Processing Eligable CEUs: CASAC/CPP/CPS - $ 50.00 Total Fee(s) for this participant Credit Card Information If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page. Checkout securely. Pay without sharing your financial information. Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 My billing address is the same as above Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States Canada State/Province * - none - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * CANCELLATION & REFUND POLICY Training registration cancellations received two weeks prior to training entitle registrants to a full refund. NO REFUNDS will be issued for cancellations received after two weeks. Refunds will NOT be made for no-shows. However, substitutions will be allowed. ANY NO-SHOW (WITHOUT PRIOR NOTICE OF CANCELLATION) WILL BE RESPONSIBLE FOR THE FULL REGISTRATION FEE.