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Form of Payment
How will you be paying for this program?
Method of Payment
(Required)
Grant
My job will be paying for it
I will be paying for it
First Name
Last Name
Email
Select one of the payment options
Payment Option
(Required)
Registration Fee - $35
Full Payment - $680
Down Payment - $340
Custom Payment
Uniform - $40
CPR Certification - $65
Payment Option
(Required)
Registration Fee - $50
Deposit (Weekly Payment Plan) - $750
Custom Payment
Custom Payment Amount
(Required)
Total
Hidden
Registration Fee Paid
Hidden
Deposit Fee Paid
Hidden
Various Payment Processed
Credit Card
(Required)
Card Details
Cardholder Name
Comments
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