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Select Course

Course Location

Course Dates

Full Name

Phone Number

Email Address

Male or Female

Company Name (if applicable)

Facebook URL (if applicable)

LinkedIn URL (if applicable)

Exact Name for Certificate

Referred From?

Payment Method
-PayPal, Credit Card, Debit Card: Complete this form and click 'Submit' below, then process payment by selecting the desired course below this form and click the 'Pay Now' button.
-If by Check: submit this form and contact us for further instructions.

Signature

Name entered in the signature box below (must match cardholder's information) authorizes LaSorsa & Associates to accept full payment of the course registration fee selected above. Payment must be made in full in order to complete the registration unless a payment plan has been authorized. No refunds once confirmed – you may request to attend another course at a later date within 12 months. If hotel package is selected and registration confirmed, deferring to another course date may add additional costs/fees.

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Ensure to click ‘Submit’ with a completed form above:

Then make payment below to complete your registration.

If paying by Credit Card or PayPal – A PayPal account is NOT required to make payment below with a credit card.

 


Select Amount



*In order to maintain compliance with ITAR&§120.9 registrants may be subject to an identity and legal status verification. Prior to the first day of class, you will be required to provide proof of citizenship or legal status. Additionally, although our courses are open to the general public, if you have a felony conviction on your record, you may face licensing and permit restrictions in most states – this is for your awareness only – Registration fees are non-refundable.*

Protective Security Group