2023 ASCM Los Angeles - Education Course Attendee Registration
This online registration form is for an ASCM Los Angeles certification or education course.  The Chapter must maintain records in order for you to receive the proper credit for the course.

IMPORTANT:  You must list your First and Last name exactly as it appears on your Driver's License.  This information will be used by ASCM to validate membership and/or exam registration.

Corporate Courses:  After submitting registration form, please skip the payment step for all corporate-billed courses.

Public Courses:  Please make sure to submit payment information by selecting the link after submitting your information.  Pay for your course using our secure PayPal transaction pages.
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First Name *
Please list your First Name as written on your Driver's License or primary ID.  Please do not use ALL CAPS when entering information into any fields.
LastName *
Please list your Last Name as written on your Driver's License or primary ID.  Please do not use ALL CAPS when entering information into any fields.
Certificate Name *
Enter your full name as you would like it to appear on your Certificate of Attendance for the Course.  It is acceptable to also list any designations, like Dr. CSCP, MBA, etc.  Your certificate name does not have to match your driver's license or primary ID.
Email Address *
Please enter your email address.  This email is for ASCM Los Angeles use only and will not be shared with external or third parties.
Subscribe to Email Blasts? *
Select Yes below if you would like to receive information on upcoming chapter events, such as Professional Development Meetings or education events. Otherwise, select No.  Chapter members are automatically added to the subscription list within 60 days of becoming a member.  
Company *
Mailing Address *
Enter your full mailing address, including city/state/zip code.  For Virtual (online) courses, materials may be mailed to this location.
Member Number *
Enter your member ASCM/ISM/IMA number or indicate "Non-member".  
Membership Expiration *
Enter your membership Expiration Date or indicate "Non-member"
Contact Phone Number *
Please use the following format:    For U.S. =  (XXX) XXX-XXXX     For International numbers, please add + and country code such as +XXXXXXXXXXXX  
Gmail Address *
Please note that some documents require a Google Drive Share.    You will be required to provide a Gmail address to share documents.   
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