Secure Registration Form

Secure Lock Your credit card, and personal information is SAFE with us. When you click the "Submit" button all information transferred through this form is encrypted using SSL technology, the internet standard.
Online Courses:
CSRS Pre-Retirement
Social Security 		FERS Pre-Retirement
New Employee Orientation
Pricing:
1 Course: $79.00 Per Person
2 Courses: $109.00 Per Person
3 Courses: $129.00 Per Person
4 Courses: $139.99 Per Person

*Discounted tuition as low as $29.00 per person for larger participant enrollments*
(If you are enrolling two or more persons please contact us for pricing)

1-800-892-2632 or E-mail

Please complete this form. * Required Fields

* First Name:  
* Last Name:
* Agency:
* Street Address:
* City:
* State:       * Zip:
* Phone:

Fax:

* E-Mail:
* Confirm E-Mail
Number of Attendees:
 



Payment Information
PBS accepts VISA, MasterCard, Discover and American Express

Please Mail Copy to:
Personal Benefit Services of Colorado
5620 Ward Road, Suite 100
Arvada, CO 80002
Or Fax to 303-420-8082
* Form of Payment:
Check all that apply
 Training Form/Document DD1556/SF182 (Please Mail Copy)
 Government Credit Card (Please provide CC information below)
  Personal Credit Card (Please provide CC information below)
Discount Coupon Code:
 
PBS Federal ID: 06-1650807
  Government Credit Card Information
Cost: $550.00 per attendee*($100.00 additional for spouses)
*Discounts for multiple attendees from the same office:
5-9 attendees: $30.00 off each participant's tuition
10+ attendees: $75.00 off each participant's tuition
Total Number of People Registering on Government Credit Card:

Total Amount Charged $

Make sure to figure in discount if more than 5 people

Account Number:

 Expiration Month

    Year

 Card Verification Number :

What is Card Verification ?

  Name on Card:

 Email Address of 
Credit Card Holder:

Billing Zip Code of credit card:
  Personal Credit Card Information
Cost: $550.00 per attendee*($100.00 additional for spouses)
*Discounts for multiple attendees from the same office:
5-9 attendees: $30.00 off each participant's tuition
10+ attendees: $75.00 off each participant's tuition
Total Number of People Registering on Personal Credit Card:

Total Amount Charged $

Make sure to figure in discount if more than 5 people

Account Number:

Expiration Month 

    Year

 Card Verification Number :

What is Card Verification ?

 Name on Card:

 Email Address of 
Credit Card Holder:

Billing Zip Code of credit card:
  Persons interested in enrolling via phone are welcome to call us at: 1-800-892-2632

After submitting your online registration you will receive a confirmation via E-mail with a login and password within 24 hours.

Persons interested in enrolling via phone are welcome to call us at: 1-800-892-2632

      

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