"*" indicates required fields 16 CEU Course: Medicare Do’s and Don’ts, 4 Board Hours, 4 Additional Hours(Additional 4 hours varies and will be posted on the schedule) Instructor: Amy Wood DC, MCS-P, CPCOClass Date You Are Registering For Saturday: 8:30am - 5:30pm with a 1-hour break for lunch Sunday: 8:30am -12:30pm for 4 Board Hours 1:30pm – 5:30pm for CBD Hours Location: Online Cost: $300.00 for each DC 16 hours. This includes CEU payment. $200.00 for each additional Non-DC staff member (Must attend withDC) $250.00 for each DC 12 hours. This includes CEU payment. $125.00 for each additional Non-DC staff member (Must attend withDC) $200.00 for each DC 8 Hours choice of day. This includes CEUpayment. $250.00 Non-DC staff member for both days without DC attending. $150.00 for Non-DC staff member for one day of choice without DC attending. $200.00 for DC students (No CE Hours) DC 16 Hours (Medicare Do's and Don'ts + 4 Board Hrs+ 4 Add.) Price: # attendingStaff Member Attending With DC. Both Days Price: # attendingDC 12 Hours (Medicare Do's and Don'ts + 4 Board Hours) Price: # attendingStaff Member Attending with DC (12 Hours) Price: # attendingDC 8 Hours (Your choice of day) Price: # attendingStaff Member Attending W/Out DC Both Days Price: # attendingStaff Member Attending W/Out DC One Day Of Choice Price: # attendingStudent Price: # attendingTotal Method of payment: Venmo(@c3-plus) Check Credit Card (3% fee) Please mail your check to: C3 Plus 7388 CR 1144 Leonard, TX 75452 and payment must be received before the scheduled class. If payment is not received within 2 days of the class, we will contact you and another form of payment will be required.Credit Card InformationCredit Card #ExpCVVZip CodeSignature*Date* MM slash DD slash YYYY Provider InformationNameTx License #AddressCityStateZipPhoneEmail Add RemoveEmailThis field is for validation purposes and should be left unchanged.