*Name of Class:
Date(s) of Class:
THIS IS A SECURE TRANSACTION*.
Will Mail Payment
*3 digit Security Code:
Name of Cardholder, as it appears on the Card:
If you prefer to pay by mail, please print this
registration form and send it with your payment to:
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
No refunds unless notified within 48 hours of class.
Refund reflects $10.00 material/processing fee. Full refund
if canceled by Marshall Hospital.
*This form uses Verisign SSL secure encryption. You may
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on the Verisign icon at the top of the form to verify
Marshall's registration with Verisign.