First Name:			*
Middle Name:				(if applicable)
Last Name:			*
Home Address:			*
Municipality:			*
State/Province:
Country
Zip Code:			*
Email:			**	Your Registration information will be sent to this address.
Home Phone:			*	(include area code)
Secondary Phone:				(include area code)
Credit Card Type:		Visa MasterCard Check or Phone	*	Your Credit Card will not be billed until your registration has been approved by CNCB. Alternatively, you may mail a cheque to the address in the confirmation email or phone in credit card payment to 416-736-5537
Credit Card Number:			* *	Visa/MCard 16 Digits, AMEX 15, no spaces.
Expiry Date:			*	MM/YY
Exam Date:		YY/MM/DD	**

---

TERMS AND CONDITIONS OF REGISTRATION FOR INTERNET ACCESS TO THIS COURSE

The following terms and conditions of registration constitute a legal agreement between you and the Clinical Nutrition Certification Board and Captus Press Inc. for access to the CNCB Online Examination.

This agreement gives you the right to access the exam between the specified dates. The exam period is for 3 hours straight, no exiting and returning to the exam is allowed  You cannot transfer or assign these rights (along with the access codes or passwords that you obtain from CNCB and/or Captus Press), and you cannot allow any other individual or organization to use these educational materials.

Unauthorized use or reproduction of CNCB educational materials in any form is prohibited. No part of these educational materials may be reproduced, distributed or stored in any manner or form by any means, electronic or otherwise, without the prior written permission of CNCB Intellectual property rights and copyright ownership regarding these educational materials rest with CNCB. These educational materials are also protected under US, Canadian and international copyright laws and treaty provisions.

The course fee paid to Captus Press Inc. is for reasonable Internet access to this learning material for the period indicated above. As the Internet host of this material, Captus Press Inc. makes no representation whatsoever as to the result or benefit of writing this exam for any purpose.

  I am registering for this exam and I affirm that I have read and understood the terms and conditions of registration stated herein. I agree to be bound by these terms and conditions and to pay the course fee