3- Month Surgical Tech Program Please enable JavaScript in your browser to complete this form.Todays Date / TimeDateTimeRegistrant's Name *FirstLastAddress *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Course Information Course Name your interested in *How did you hear about this program *Is this your first time registering with New Career Institute *YesNoAre you affiliated with another school or training program *YesNoHave you ever been terminated from a school or training program *YesNoEmergency Contact Emergency Contact Name *FirstLastEmergency Contact Phone *Emergency Contact Email *$150 non-refundable application fee is due upon initial enrollment. Payment of the application fee does not guarantee a spot in the program. A minimum, refundable $1000 tuition fee is due when you register. The balance of the tuition is due when accepted into the program. If payment is not received according to the agreed upon payments , the student will not be allowed to start the class. I understand that New Career Institute will take legal action for any credit card chargebacks. I understand that valid photo ID is required with all credit card payments. I understand and agree to these terms before providing payment information * *YesRegistration Payment Emergency , according Course Fee *Price: $1,000.00Please Enter Your Credit Card *Single Line TextRegister