AACN E-Learning End-User License Order Form

If you are an existing AACN E-Learning customer with a valid site license, please use this form to order additional end user licenses.

Your Information

*Your Email Address:

*Your First Name:

*Your Last Name:

*Do you currently have a Learning Management System? Yes
No

*Type of Facility:

*Number of Beds:

*Area employed:

*Primary position:

Please enter the number of end-user licenses you wish to purchase.

Essentials of Critical Care Orientation

Basic ECG Interpretation

Essentials of Nurse Manager Orientation

The Preceptor Challenge: The AACN Preceptor Development Program

Promoting Excellence in Palliative and End-of-Life Care

Essentials of Pediatric Critical Care Orientation

AACN: Critical Care Pharmacology

Additional full-content site manager account(s)

Additional administrator-only site manager account(s)

Please enter the legal facility name and address included on the site license service agreement.

*Organization's Complete Name:

*Country:

*Address:

Address 2:

*City:

*State:

*Zip/Postal Code:

*POC First Name:

*POC Last Name:

*POC Title:

*POC Email Address:

*POC Phone Number: -- ext.

We accept checks, credit cards and EFTs.

Credit cards:: Please complete the information at the bottom of the E-Learning invoice and fax to 949-448-5521.
EFT:: Please advise us so we are aware of the incoming wire.

Purchase order: This is for your reference only. AACN does not accept PO's as payment.

Your Purchase Order # for this order: