Pay Online | Missouri Assisted Living Association

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Pay Online

First Name

Last Name

Email

Additional Email Address

If you would like the payment receipt to be sent to additional recipients, enter their email address(es) here.

Phone

Facility Name

Payment For:

If you have an invoice from MALA with an invoice number, please select “Other Invoice”

Which certificates are you requesting? ($10 per certificate)

Level 1 Medication Aide (LIMA) Certification

Insulin Certification

Level 1 Medication Aide/Insulin Instructor Certification

ALF Resident Assessment Certification

Requested Certificates Total

$

Number of DHSS L1MA Certifications Requested

Request for DHSS L1MA Certification when DMH Certified Total

$

Number of MALA Members ($20 per student)

Number of Non-Members ($30 per student)

Member/Non-Member Total

$

Number of MALA Members ($10 per student)

Number of Non-members ($20 per student)

Member/Non-Member Total

$

Invoice Number

Amount from your invoice

$

Train the Trainer Registrant Name

Train the Trainer Total

$

Convenience Fee

$

I understand a 2.9% plus 30¢ convenience fee will be applied to all credit card transactions.

Yes

Grand Total

$

Payment

Billing Address

Billing Address

Billing Address

Billing Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

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