18-19 APICS Los Angeles Chapter Education Course Attendee Registration/Information
This online registration form is for an APICS Los Angeles Chapter 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 as it appears on your Driver's License. This information will be used by APICS to validate membership and/or exam registration.

In-house or 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.

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.
Your answer
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.
Your answer
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.
Your answer
Email Address *
Please enter your email address. This email is for APICS Los Angeles Chapter use only and will not be shared with external or third parties.
Your answer
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 *
Your answer
Mailing Address *
Enter your full mailing address, including city/state/zip code. For online courses, materials will be mailed to this location.
Your answer
Member Number *
Enter your member APICS/ISM/IMA number or indicate "Non-member".
Your answer
Membership Expiration *
Enter your membership Expiration Date or indicate "Non-member"
Your answer
Contact Phone Number *
Please use the following format: (XXX) XXX-XXXX For International numbers, please add + and country code.
Your answer
Citizenship Status *
Course registration requires information on citizenship status due to the security requirements of the facility. You will be required to show proof of ID and attest to citizenship status prior to entry. If "Other", please provide specifics.
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