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Participant's First Name

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Birth Date (FIRST, select year, then month, then date)

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School

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ZIP Code *

Prepaid Cards: You may need to call the phone number on your card to activate it before completing online transactions. Please ensure that the address on file matches what you enter in the billing details above.

Course Details

Item	Amount
Anti-Hazing Education × 1	$4.99
Subtotal	$4.99
LA Sales Tax	$0.42
Total	$5.41

Credit Card

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Expiry (MM/YY) *
Card code *

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IMPORTANT: DO NOT REFRESH THIS PAGE! Your payment may take a moment to process. To avoid duplicate charges, do not refresh, resubmit or close this window until you have been redirected to the THANK YOU page. (If you are unsure if your payment has processed, click the MY DASHBOARD link to view your course payment status.)

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Billing Details (for the credit card or debit card holder)

Course Details

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