Kenvic Professional Training
Professional License Examination Preparation
1-888-939-6996
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Registration
Prospect students can register with us in person, by calling us, by mailing or by filling the following registration form.
In Person: we are located at 137-28 Northern Blvd Flushing, NY 11354
By Phone: calling us at 718-321-3322
By Mailing: filling and submitting the following form, mail a check (payable to Kenvic Professional Training) to:
Kenvic Professional Training
137-28 Northern Blvd 2nd Floor
Flushing, NY 11354
For any question, please call 718-321-3322 or Email us at
info@kenvictraining.com
*Required
Student Information
*
First Name:
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Last Name:
Middle Name :
*
Cellphone # :
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Fax # :
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Email:
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Address:
Mailing Address
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City:
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State/Province:
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Country:
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ZIP/Postal Code:
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Emergency Contact:
(Last Name, First Name)
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Emergency
Contact Number:
000-111-2222
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Emergency Contact:
Friends, Wife, Husband)
Making a Payment
Note:
for payment by check, please leave the following blank, go straight to the end and click "Submit". You may refer back to the beginning of the registration form for further instruction.
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if it is different from your mailling address
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Agreement
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I agree that Kenvic Professional Training charges the above amount to my Credit Card listed in the form.
I don't agree that Kenvic Professional Training charges the above amount to my Credit Card listed in the form.
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Tel: 1-888-939-6996
Email: info@kptus.com
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