PCT Exam Registration

To register enter the information below and then click on "submit" ~ you will then be taken to the payment page.

Payment must be made before registrations can be process.

Register Please select an item.
First Name
Required. 
Middle Name
Full Middle Name ~ Not just an initial
Last Name
(Surname)
Required. 
Address
Required.
City
Required.
State Required.
Zip A value is required.Invalid format.
Home/Cell Phone A value is required.Invalid format.
Email
A value is required.Invalid format.
CHT Cert # Required.
(Enter PENDING if you don't have one yet) 
Date of Birth  (MM/DD/YYYY) A value is required.Invalid format.
Name of your Clinic or Training School
Clinic/School Phone Invalid format.
Exam Application Type:

     Early Registration $175   (Now applies for the March Exams)
     Late  Registration $200   (Now applies for the February 14th Exam)

To go to payment page. Note: Registrations cannot be completed until payment is made.