Edulog Virtual Learning Academy Registration

Information for up to 5 Users
Name of User #1*
First Last
Email of User #1*
Name of User #2
First Last
Email of User #2
Name of User #3
First Last
Email of User #3
Name of User #4
First Last
Email of User #4
Name of User #5
First Last
Email of User #5
Payment Options
Edulog Virtual Learning Academy Option*
Please select the quarter or annual option in which you would like to enroll your team.
Please select how you will be paying for your academy registration*
Please choose Bill Me or Credit Card. Please be aware that you are not being charged right now. We will contact you after you have submitted this form to process your final payment details.
PO number
If you have a PO number, please enter it here.
Credit Card Transaction Fee
Please note that there is an additional 4% fee for credit card transactions that will be applied when we contact you to process your final payment details.
Price: $0.00
Additional Notes
Please use this field to let us know any additional details about your registration, additional payment information, or other details.
Total
Please note that this estimated total does not include credit card processing fees. We will contact you after you have submitted this form to process your final payment details.
$0.00
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Email
This field is for validation purposes and should be left unchanged.

Information for up to 5 Users