Course Registration Course Registration Form "*" indicates required fields Registration: A minimum deposit of $500 is required upon registering for the basic MLD certification or full CLT certification program. CE Credits: We are accredited providers of continuing education through NCBTMB and BOC. Most states accept these credits for allied health professionals, (i.e. RN, PT/LPTA, OT/COTA, CMT/LMT etc.) It is up to you to check the requirements of your state. Cancellation Policy: Refunds can be received up to 30 days before the course starts with the reduction of a non-refundable $50-$100 deposit depending on the program. Within 30 days of course start-date, the amount can be credited toward enrollment in a future course. Payment Plan: If you are requesting a monthly payment plan, you need to contact us directly via phone or email to discuss your options. Course SelectionMLD Certification CourseI am registering for (check one)* Full MLD/CDT Certification Course Basic MLD Certification Course DEPOSIT Basic MLD DEPOSIT Full MLD/CDT Lipedema: Early ID to Treatment Neuro-Lymphatic Therapy (Live, In-Person) Neuro-Lymphatic Therapy (Recorded or Live Virtual Webinar) Intro to MLD (Recorded) Recertification Fibrosis: The Missing Link in Lymphedema Treatment - FL Custom Webinar Name Webinar (if selected) Custom Custom (if Selected) Total Coupon Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Registrant InformationFirst Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Workplace Occupation License Number State Licensure Licensure InformationNOTE: Please include a copy of any and all licensures with registration, unless already on file.File Upload Drop files here or Select files Accepted file types: doc, docx, txtpdf, jpg, png, gif, Max. file size: 2 MB. Student AgreementPlease click here to read the Student AgreementI have read, agree to, and understand the student agreement.* I agree Please note: Final certification will be held until all payments are complete, though you will receive your CEU certificates as you finish each part of the course.Submit Your InformationCAPTCHAEmailThis field is for validation purposes and should be left unchanged.