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Annual Education Provider Registration Form

Contact and Billing Information
Education Provider/Company: *
Company Main Address: *
Company Main Address (2):
City: *
State/Province: *
Zip/Postal Code: *
Country: *
Website:
Main Contact Person: *
Main Contact Title: *
Main Contact Phone: *
Main Contact Email Address: *
   
Agreement
Please click here to read Course Approval Requirements and Guidelines document.

By registering to be an IHS Education Provider, I understand that IHS reserves the right to withdraw approved provider status at any time for failure to abide by these requirements: (Check each box)

Thoroughly read all education provider information.
Abide by the Course Approval Requirements and Guidelines document
Agree to fees and payment policies


Annual Registration Fee
The Annual Registration Fee is due every year (and is based on the calendar year) prior to your first course application. Payment of this fee must be submitted with the annual registration form.

Education Provider Annual Fee   $400 USD
IHS Chapter Annual Fee $250 USD

To expedite processing the registration form, please provide a credit card to pay the annual fee. Once the registration is accepted, the credit card will be charged. IHS will send you an email message with a receipt and your company’s Education Provider Number.

Payment Method
Choose your method of payment Visa MasterCard American Express Discover
Name on Card
Card Number
Expiration Date
Security Code

If you are unable to pay by credit card, an invoice will be emailed to you. Please note, courses will not be approved until payment for the annual registration fee is received.

If you have any supporting documents to accompany this application, please email the documentation directly to education@ihsinfo.org.

For questions regarding IHS course approval email education@ihsinfo.org.