AgriSafe Nurse Scholar Program Group Seat Purchase Form

To purchase group seats for the AgriSafe Nurse Scholar Program, please complete the form below. Once your transaction is processed, you will receive an email from Koby Schexnayder (kschexnayder@agrisafe.org) containing detailed instructions on how to access your purchased seats.

Before completing your purchase, please review the AgriSafe Nurse Scholar Program – Group Seat Pricing Structure. If you have any questions or would like additional information, contact Ansley Fey (afey@agrisafe.org).

Office Hours: AgriSafe’s office is open Monday through Friday, from 8:00 AM to 4:30 PM CT. Any inquiries submitted outside of these hours will be addressed on the next business day.

Group Seat Purchase Form – Nurse Scholar

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Organization Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Payment Details

Nurse Scholar Program (price per learner)(Required)

Nurse Scholar (purchaser fills seats) – $500

Nurse Scholar (AgriSafe fills seats) – $1,000

I have read the AgriSafe Nurse Scholar Program – Group Seat Pricing Structure and understand the requirements for the price per learner option selected.(Required)

Yes, I agree.

Number of Course Seats Needed(Required)

Please enter a number greater than or equal to 2.

Total

How would you like to pay?(Required)

Pay by credit card

Pay by check

Pay by invoice (minimum purchase 10 seats)

Credit Card(Required)

Card Details

Cardholder Name

AgriSafe Nurse Scholar Program Group Seat Purchase Form

Group Seat Purchase Form – Nurse Scholar

Payment Details

Categories

Engagement

Navigation

Contact Us