TNA Clinical EEG Program Tuition Payment Plan Contract Students interested in making payments throughout the TNA Clinical EEG Program HiddenNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.Your Name(Required) First Last Social Security Number(Required) Your Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Email Address(Required) Email Address Confirm Email Address Your Phone(Required)E-signature Student agrees to pay TNA $7,500.00 for the Courses offered. By completing this form student has agreed to pay $536.00 for a total of 14 months. Student must place a credit or debit card on file with TNA, and authorizes TNA to automatically withdraw such payments on the dates due. Late Payments. In the event any payment due under this Agreement is returned as non-payable, or is otherwise not made when due, Student authorizes TNA to collect a $100 late fee and double payment on the date the next payment is due. TNA reserves the right to withhold Training from any Student not current on payments. If the student defaults on payments they are aware their account will be sent to collections and a negative reflection on your credit report.PhoneThis field is for validation purposes and should be left unchanged.