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Step #1 - Attendee Information
Name of Student Taking the Course
Email Address of Student
Mailing Address of Student
Credentials of Student
Select one...
RN
APRN
PA-C
MD/DO
Other
Phone Number of Student
Name of Practice (if Applicable)
If someone other than the attending student is registering, please complete the following
Name
Practice Name
Position in Practice
Email Address
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