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First Name:*
 
Last Name:*
Name you go by:
   
Wk. Address:
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Mail Code (MC):
BEMS ID:*
Date of Birth (DOB):*
         
Home Address:
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Choose:
Supervisor Name
 
Supervisor Address:
Supervisor MC:
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Supervisor Phone:
         
Local Emp:
Natl Emp:
Employee Title:
Class Day of the Week:
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Sales Rep:

Amt Due:
 Company:
   
         
Our refund/transfer policy extends as follows:
Student may cancel the contract seven (7) business days prior to the commencement of the program at no penalty by notifying the school in writing before the course begins.  Any monies paid to the school in excess of the sum due the school by the student who cancels, withdraws or is discontinued will be refunded with thirty (30) days. Students may transfer into another class or register a substitute one (1) time without penalty. Each subsequent request to transfer will incur a fee of $100.00, which must be paid in full at the time of transfer. Students who successfully meet the completion requirements of their course and are not satisfied with the program may re-enroll in the same program at no charge for up to one year.