This online registration form allows you to register and pay for your class in one easy step. The down payment for this course is required to complete registration (payment information will be collected at the end of the form).

If you would prefer to mail in a registration form, you can download the Registration Form (PDF).

All fields are required unless otherwise noted.


Course Information:

Semester

Montana

Jun 17, 2019 - Aug 17, 2019

$17,000.00

Course Details:

Thank you for your interest in our Summer Semester.  We are still accepting applications for Summer 2019!

Your Contact Information:

Emergency Contact:

Your Background Information:

Billing Information:

This course begins within 30 days, so a payment of the full course cost ($17,000.00) is required.
Enter a number only (no spaces or dashes).
Month
Year
This number can be found on the back of your card.

Billing Address

If you have any questions about the requirements or risks involved with this course, please contact us.


Please review all of your information before submitting your registration.
Your credit card will be charged as soon as your registration is successfully submitted.

Note: Aerie will send system-generated emails from info@aeriemed.com. These emails contain valuable and necessary course information. To ensure proper delivery, please check your spam/junk folders and mark info@aeriemed.com as an approved contact.