Customer Information

Quick Registration

Customer Information

Certificate Starfield Secure You are enrolling in our Advanced Gambling Addiction Class. Please enter your certificate delivery information below. Then click Continue to Payment to choose your payment method.

Certificate Shipping Address

First Name:

Last Name:

Street Address 1:

Street Address 2:

City:

State / Province:

Zip / Postal Code:

Country:

Telephone Number:

Email:

Reason for Registering

Reason for Registering:

To satisfy a Court or Legal Requirement

Educational or Personal Reason

If you are registering to satisfy a court or legal requirement, please enter your birth date and court case number below in order for us to properly generate your certificate.

Birth Date:

Use the format MM/DD/YYYY, for example 04/25/1986. You must include the slashes.

Court Case Number:

(only if you have one)

Member Account Information

Once you have registered for your class, you will need a user name and password to access the members area.

Create Login ID:

Create Password:

Confirm Password:

Product Selection

Name:

Advanced Gambling Addiction Class

Price:

$195.00

Offer Code:

(only if you have one)

Choose Certificate Delivery

Certificate Delivery:

US Mail (delivered in 7-10 business days)

Third Day ($19.95)

Second Day ($24.95)

USPS Express Mail (1-2 business days) ($39.95)