Student Registration Form
A+ Coding Institute
348 Sweet Ashley Way
Loganville, GA 30052
678-684-8855
http://www.apluscodinginstitute.com
Course of Interest
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Which Course are you registering for?
CPC Course
CPC-H Course
Terminology, Anatomy and Physiology Combo
Anatomy Only
Terminology Only
Online Anatomy and Terminology for ICD-10 Coding
CPC Boot Camp (3-day intense exam prep)
simplifying ICD10 (2-day training)
2012 Coding Changes (1 day)
Examination Review Class (1 day)
Student Personal Information
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First Name
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Last Name
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Date of Birth
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Last Grade Completed
High School Graduate
GED
Some College
College Graduate
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Sex
M
F
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Address 1
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City
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State
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Zip
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Phone
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Contact email
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Preferred method of contact?
Email
Phone
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