Counselor Enrollment Form

The counselor registration are for members within a company with a training manager
and should only be registered by the company representative. For those who are tracking
their own certification status and examination should register as a company.

            Required fields are marked with an asterisk (*)
Counselor Name
First Name: *
Middle Name:
Last Name: *
Contact Info
Email Address: *
Telephone: *
Phone number can only contian numbers. Spaces, dashes/hyphens, and parentheses are not allowed
Certification Info
Certification: *