Form Center

2. Instructions
   Complete the form below to process payment for classes at the Ben Clark Training Center. Please remember to enter your confirmation INVOICE NUMBER. Only one transaction per student will be accepted.
4. A three percent none-refundable transaction fee will be charged, or a minimum of $2.00 per transaction.
6. Course Title*
7. Class Date*
   Class Date
9. Agency*
11. Course Cost
    One Student Per Transaction
12. Price Per Student*
13. Quantity
14. Shipping Cost
16. Taxable
18. Student’s First Name*
19. Student's Last Name*
20. INVOICE NUMBER*
22. Training Coordinator / Liaison *
24. Training Coordinator / Liaison Email Address*
Leave This Blank:


25. Calculate Totals Proceed to Checkout

* indicates a required field