Student Name:__________________________________________________  Email:______________________________________________

Address:________________________________________________   City:_______________________________   Zip:______________

Course Date: ________ /_________ /_________         Workshop #: ____________________________________        Amount paid: $125

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COURSE DESCRIPTION:   □ AWHONN Advanced FHM

Course cost: $125* (plus student materials, tax, S&H)

* Student Materials required for AWHONN courses, see below                
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​Pay $125 for course fees by:      [  ]  Check or money order​​          [   ] PayPal - Tomsgirl63@gmail.com​          

​​[  ] Venmo - KlevGirl           [  ] Credit/debit card:      Visa   /   MasterCard   /  AmEx  (circle)
     
                            [  ] ​Apple Pay (951) 951-236-8117           [   ]   Zelle 951-236-8117 
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   Credit/Debit Info:  Name on Card _____________________________________________  

​​                                   Billing Zip Code:  _________________   Exp Date__________________
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                                   Card # ​​__________________________________________________

​​                                   3 Digit Security code on the Back of Card: _________





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* AWHONN Course Materials: Student material packs are required for all AWHONN FHM classes. The cost for the Advanced FHM student materials         is approx. $125 (incl tax, S&H).
​Purchase student materials before class from Kendall Hunt. Allow 1-2 weeks for delivery of hard/paper materials.  They must be 6th edition!
Kendall Hunt 1-800-228-0810 You will need the course date and Workshop #.
​The ISBN # for a hard/paper copy of the materials is: 9781792487828
An electronic version of student materials is also available for immediate download. The ordering ISBN # for digital materials is: 9798765777817
​​The exam is taken at home after the course. You will need the code from new 6th ed AWHONN Materials to complete the exam and course evaluation
Mail completed form and payment to: Karen Kleveno MSN-Ed
​ The Rockin' K Ranch:  16105 Reiner Cir Riverside, CA 92504
Email: FetalMonitoring.Education@Gmail.com​    Phone: 951-236-8117
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​​REGISTRATION CHECKLIST:
[    ]  Download & complete class application
[    ]  Mail application with payment of $125 (cash, check, PayPal, Venmo credit/debit, Zelle, or Apple Pay) to 16105 Reiner cir Riverside, Ca 92504.
​     If you are paying with credit/debit, Venmo, PayPal, Apple Pay or Zelle you may take a photo of the application and text or email it 
[    ]  Order student materials from Kendall Hunt. Electronic materials are now available for immediate download or paper/hard copies may be purchased (please allow at least a week for shipping of paper materials). Both versions are available through Kendall Hunt at 1-800-228-0810
Ordering info for paper materials: ISBN # 9781792487828
Ordering info for digital materials is: ISBN # 9798765777817
[    ]  Be sure to download Zoom before the day of class. The free version is perfect for students
[    ]  Log into Zoom between 8:45 to 9:00. We start promptly at 9:00 
​YOU MUST ORDER STUDENT MATERIALS FROM THE PUBLISHER
See below
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Do not send your application requiring a signature. I am usually not available to sign for packages or letters. ​Thanks!
​AWHONN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accredidation

AWHONN also holds a Caifornia BRN number: CA CNE Provider #CEP580

Accredited Status does not imply endorsement by AWHONN or ANCC​​​​​​ of any commercial products displayed or discussed in conjunction with an activity
By completing this application and registering for this course, you accept all responsibility for any injuries which may occur while on the premises, attending class. ​The Rockin' K Ranch, its owners, and the class instructors accept no responsibility for lost items or injuries resulting from course participation.
Square is used to bill credit/debit cards. How do you prefer to receive your credit/debit receipt?
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