ETI Technical College
2076 Youngstown-Warren Road
Niles, OH 44446
330•652•9919

Registration Form
LPN Limited IV Therapy Course

Print Name______________________________________________________________

Signature _______________________________________________________________

Last 4 digits of Social Security Number:_________________________________________

Address_________________________________________________________________

City______________________________State____________________ Zip___________

Home Phone(____)________________________Date of Birth:______________________

Work Phone(____)_____________________Cell Phone(____)_____________________

e-mail__________________________________________________________________

Job Title ________________________________________________________________

Employer________________________________________________________________

REFUND POLICY:  If a participant withdraws before the first class a $10.00 cancellation fee will be assessed.  Any participant who withdraws before the start of the second scheduled day of class will receive a 100% refund minus a $25.00 withdrawal fee and the cost of books and materials. 

NO REFUNDS WILL BE GIVEN AFTER THE SECOND SCHEDULED CLASS.

Payment Method:
______ Check or Money order (to ETI Technical College)
______ I am requesting Nursing Contact Hours
______Day program                _______Evening program
* Credit Card payments must be made on site at the
Administrative Building of ETI Technical College.

Program Cost: $550.00

Please mail the Registration Form to:
ETI Technical College
Attention: Registration for IV Therapy
2076 Youngstown-Warren Road
Niles, Ohio 44446
Phone: 330-652-9919