Registration and Payment Form Help
This document describes the process for completing the registration and payment forms by explaining the information you need to type into each field.
Required fields are those which we need to process your registration and payment. Our transactions are secure and we do not share your information. Please see our security and privacy policies (use the Quicklink at the right) for details. |
 Quicklinks
Security and Privacy
FAQs
Course list
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| Customer Information |
| FIELD NAME |
INSTRUCTIONS |
| First name (required) |
Type your first name as you want it to appear on your certificate. |
| Last name (required) |
Type your last name as you want it to appear on your certificate. |
| Address (required) |
Type your mailing address. |
| Address line 2 |
Continue your mailing address to a second line, if needed. |
City
(required) |
Type the name of your city. |
| State or Province (required) |
This is a drop-down list. Click on the icon at the right of the field and scroll to find your state or province. If it isn't on the list, select “Other”. |
Other State
or Province |
Type the name of your state or province (or similar) in this field if you selected “Other” in the State or Province drop-down list.. |
| Country (required) |
Click on the icon at the right of the drop-down list and scroll to find your state or province. |
Postal Code
(required) |
Type your zip code or postal code. |
| E-mail address |
A confirmation of your registration and payment for each course you take will be sent to your e-mail address if you provide it here. We do not share our e-mail database or sell it to third parties. |
| Telephone |
A phone number will allow us to contact you if necessary. Please include your area code and, if your number is outside the U.S., your country code and city code. |
How did you hear about
Wild Iris? |
This information is helpful for us to determine how our customers find us. |
| |
|
| License Information |
| FIELD NAME |
INSTRUCTIONS |
License type
(required) |
Click on the icon at the right of the drop-down list and scroll to find your license type. If you don't see it, select “Other”. |
| Other license |
Type the name of your license type in this field if you selected “Other” in the license type drop-down list. |
License number
(required) |
Type your license number.
If you do not have a license number, type four zeros (0000).
Special note for Florida customers: You must type your license number exactly as it appears on your license (ex. RN4289730) to have your transaction automatically reported to CEBROKER. |
License
expiration date
|
Click on the icon at the right of each drop-down list to select the month, day, and year that your license expires. |
| State or Province (required) |
Click on the icon at the right of the drop-down list field, then scroll to select the state or province in which you are licensed. |
| Additional Information needed from EMTs and Paramedics |
NREMT number
(required) |
Type your NREMT number in this field. (Applies only to EMTs and Paramedics) |
| NREMT expiration date (required) |
Click on the icon at the right of each drop-down list to select the month, day, and year that your NREMT license expires. |
| Additional Information needed from New York State customers |
Birthdate
(required) |
Click on the icon at the right of each drop-down list to select the month, day, and year that you were born.
This information is required by the New York State Department of Education.
|
Social
Security Number |
Type your social security number in this field.
This optional information is requested by the New York State Department of Education.
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| Special Code |
| If you have a discount code or an organization code, type it in this field. |
| E-Mail Newsletter |
| Click the checkbox to subscribe to the Wild Iris Medical Education E-mail Newsletter. The newsletter is sent quarterly and you may unsubscribe at any time. We do not sell or share our e-mail address list. |
Payment Options
You have the choice to register and pay online, or to print your registration information and mail or fax it with your payment. Click the button for the option you choose.
If you choose to register and pay by mail/fax, the form you print includes instructions and mailing/faxing information. The following instructions pertain to online registration and payment.
Special Notes regarding Free Courses
If you took a free course, you will not be required to submit a credit card in order to complete your registration online. (You will not be asked for any payment information at all.) We do not mail certificates for free courses unless you send us a self-addressed, stamped envelope. (See the Certificates FAQ for details.)
Online Payment
| Payment Information |
| FIELD NAME |
INSTRUCTIONS |
Cardholder name
(required) |
Type your name exactly as it appears on your credit card. |
Credit card type
(required) |
We accept American Express, Discover, MasterCard, and Visa. Click on the icon at the right of the field to select the credit card you are using. |
Card number
(required) |
Type the card number in this field. You don't have to use spaces or dashes. |
Expiration date
(required) |
Click the icon at the right of each field to select the month and year that your credit card expires. |
| Credit card billing address |
If the billing address for the credit card you are using for this transaction is different from the address you entered on the registration form, you need to provide the billing address for the card in this section. |
Click the “Continue” button at the end of the form when you are ready to proceed. Your credit card will not be charged when you click this button. You will have the opportunity to view the information you have provided and verify or change it.
Verify Your Information
This screen displays the information you have entered. Review it for accuracy. If you need to make changes, click the “Edit My Information” button at the bottom of the page.
If the information is correct and you are ready to submit your payment, click the “Send Payment” button. Important note: Click the button one time only to avoid being charged more than once. There may be a brief delay while your submission is processed.
Edit Your Information
This screen displays all of the information you have entered, but you can place your cursor in any field and change the information where necessary. When you are finished editing your information, click the “ Continue” button. Your credit card will not be charged when you click this button. You will have the opportunity to view again the information you have provided.
Verify Your Information
(2nd time, if you have viewed the Edit Your Information screen)
Once again, review your information to check that your changes are correct. When you are satisfied the information is complete, click “Send Payment” to submit your payment. Important note: Click the button one time only to avoid being charged more than once. There may be a brief delay while your submission is processed. If there are any problems with the transaction, follow the instructions that appear on the screen.
Registration Confirmation / Registration and Payment Confirmation
When your payment has been processed, the confirmation screen will appear. Click “Print My Certificate” to display and print your certificate.
Important note: If you do not provide an e-mail address on the registration form, you will not receive an e-mail confirmation of your transaction. You should print the confirmation screen from your web browser in order to have a copy of your transaction.
Tips for printing your certificate
Many web browsers include a default page setup which adds headers and/or footers to a web page when it is printed. This feature allows you to set the headers/footers to print a variety of information. However, in some cases, such as when you print your certificate, you may want to suppress the headers and footers.
How to suppress headers and footers when you print the certificate
To "turn off" the header/footer, follow the steps below. The terms used here are as they appear in the Internet Explorer browser (if you are using a different browser, the terms may be slightly different but the function is similar).
- Select File -> Page Setup from browser menu.
- When the Page Setup dialog box appears, delete all the text that appears in the Header and Footer fields.
- Click OK.
- Select Print to print the page (you can preview the print version first to verify that you have successfully suppressed the headers and/or footers).
Other tips for printing the certificate
The Wild Iris logo and signatures are images. If you have turned off the automatic download of images when viewing web pages, you may need to enable the images to download before printing.
You can print the certificate in color or in black and white.
Printing at a normal quality setting (rather than "quick" or "draft") will produce a sharp-looking certificate, as will using good quality paper when you print.
How to obtain your certificate if you cannot print it
There is a link at the bottom of the confirmation screen with a link to a form you can use to request that your certificate be mailed or faxed to you. Please note: We do not mail certificates for free courses unless you send us a self-addressed, stamped envelope. (See the Certificates FAQ for details.) |
