Partners Telecourse Passport Activation Form

Three Ways to Register and Pay

1. Fax registration and pay by check or credit card (off-line)
Click here to access the PDF version of the registration form

2. Register on-line and pay by check
Complete the form below and click “Submit without Payment”
Mail check to:
Partners in Medical Education;
109 Brush Creek Road; Irwin, PA 15642

3. Register on-line and pay securely by credit card
Complete the form below and click “Pay On-Line”