

Enrollment Form

First Name:

Last Name:

Street:

City:

State:

Zip:

E-mail Address:

Day Phone:

Evening Phone:

How did you hear about us?

Today's Date:

Desired course start date:

Would you like someone to call you to answer additional questions?Yes No

If Yes, what time/day would be convenient for you to receive a call?

Which number would you like us to call?

Day Phone Evening Phone

What is your preferred payment method?

Check Money Order Credit Card

Select the items below you wish to register for:
Select?	Item No	Classes	Price
	MT100	1st Quarter Medical Transcription Course	$275.00
	MT200	2nd Quarter Medical Transcription Course	$275.00
	MT300	3rd Quarter Medical Transcription Course	$275.00
	MT400	4th Quarter Medical Transcription Course	$275.00
	MT500	5th Quarter Medical Transcription Course (optional--advanced dictation)	$275.00
	MT600	Web Discount: Prepay for the four required quarters (MT100-MT400)	$950.00
	MT700	NEW! CD-based online course option, prepayment of 4 quarters (MT100-MT400). Includes .wav pedal.	$1,250.00
	XCODE	Click here if a Kamtek representative has given you an alternate pricing code.	$0.00

Press "Submit Form" to e-mail your enrollment form to the registrar and obtain payment information.

All prices include shipping and handling. All courses are tape based unless stated otherwise. Price per quarter for the tape-based program: $250.00 plus $25.00 tape deposit. $25 deposit refunded at the end of each quarter if tapes are returned in good condition.
MT600 includes one refundable $25 tape deposit, which is carried over from quarter to quarter as long as the tapes are returned in good condition at the end of each quarter.
MT700 includes one refundable $75 deposit if the CD is returned in good condition within one year from the start date of the course.
Refund Policy: Students can withdraw from any quarter at any time. Course withdrawals must be made in writing. Upon withdrawal from the course, students may be entitled to a refund according to the refund schedule. The refund schedule is as follows: If Kamtek course materials returned unused within 10 days from the date received by student, full tuition refund will be given for current quarter of enrollment, less administration fee of $25.00 + shipping. Student is responsible for shipping costs of materials returned to Kamtek. No refund entitled after 10 days from date course material received by student, or if materials returned used. Note: Students have 16 weeks in which to complete the coursework for each quarter, after which time Kamtek's instructional obligation has been fulfilled, unless prior alternative arrangements have been made between the instructor and the student. If Kamtek is unable to fulfill their instructional obligation due to unforeseen business problems or closure, the student is entitled to refund of tuition for the unused/ungraded portion of the current quarter as deemed appropriate by the Kamtek administration and (only in the case of MT600 and MT700) the unused portion of any subsequent prepaid quarters, provided the student returns the tapes/CD in good condition.
Please note: Although this course is a comprehensive college-level learning experience, it is not an accredited college course, which means that credits are not assigned, and transcripts and courses are not transferable to other institutions. This training program does not provide tax credit 1098T forms. Quarterly grade reports may be obtained from individual instructors upon request, but this is not to be mistaken for a transferable college transcript.

All prices subject to change without notice. By filling out and submitting this form, you agree to abide by the policies above.

Direct any questions to: kamtek@qualdata.com