Application and Team Training Registration Fee Processing Form

What type of transaction are you seeking to process?

Program Application Fee

Fee must be submitted in order to complete your application package.

Program Application Fee

Applicant First Name

Applicant Last Name

Which program are you applying to?

Mobility Service DogPTSD Service DogHearing DogAccredited Facility Dog

Team Training Registration Fee

Fee is due prior to the first day of class.

Team Training Fee

Candidate's First Name

Candidate's Last Name

Agency Team Training Registration Fee

Fee is due prior to the first day of class.

Team Training Fee

Candidate's First Name

Candidate's Last Name

Your Information

Legal First Name

Legal Last Name

Email

Phone

Phone Type

Country

Street Address

Address Line 2

City

Province

State

Postal Code / Zip Code

Is your mailing address the same as your billing address?

YesNo

Mailing Address

Country

Street Address

Address Line 2

City

Province

State

Postal Code / Zip Code

Payment Information

Total Payment:

Name on Card

Credit Card Number

MM

YY

CVV