To receive Professional Development Units for this course, please: 

1. Print and complete two copies of this form.  One form must be returned to Bridgeway Academy at the address below.  The second copy must be retained in your personal PDF folder as evidence of your participation.
2. Print your course scores.  You must pass this course with 70% or better to receive credit.
3. Print and complete a course evaluation
4. Return a copy of this application, your course scores and course evaluation to:

CEU Program
Bridgeway Global Academy
334 Second Street
Catasauqua, PA 18032

REGISTRATION

YES! I would like to apply for the following Continuing Education Course(s)

Name:________________________________________________________________

Address:_______________________________________________________________ 

City/State/Zip:__________________________________________________________

Phone:________________________________   Email:__________________________

Course Title:___________________________________________________________

Number of instruction/participation hours:  _____________   Score ___________

Program Number:  ________________    Date Completed:  ___________________

Name of instructor:              Bridgeway Global Academy                      Mindleaders

___  Check enclosed ($25 per unit made payable to Bridgeway Academy)  

Credit card:   VISA   MasterCard   Discover

Credit Card #_________________________________________ Exp. Date __________

 ___________________________________________________  Date _______________
Signature (required for all credit card charges)

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Office use only
Number of CEU’s awarded: ___________            Global Academy Registration #__________