Asociacion Hispana de Profesionales de la Salud,Inc NY.
Over 25  Years.

http://www.ahpsi.org
Registracion form – for Courses

Full Name -Nombre Completo-___________________________________________________

Address- Direccion completa_______________________________________________

E-Mail___________________________________________________________

Phone- Telefono___________________________________ _

Profession _________________Country – University-Graduate – Pais de Graduacion______________

□ Request registration – PCT, EKG & Phlebotomy Me gustaría registrarme Curso PCT,EKG, & Phlebotomy.

□ Request registration – Surgical Assistant program / Me gustaría registrame al curso Surgical Assistant.

Date suggested to take this course/ Fecha disponible _______________________

Favor anexar copia de titulo / attach copy of title

Approved By/ Aprobada por: ______________________________

_________________________________

Date/ Fecha: _________________________________

Make Check or Money Order to: “AHPSI”, Send to: P.O .Box 321856 , Forth Washington Station, New York, NY,10032. E-mail : info@ahpsi.org 1-888-277-1288.