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Clinic Registration
Clinic Course Registration
Complete this form to register for a clinic class.
Name of person filling out this form
*
First
Last
Point of contact for registrations
*
First
Last
Address
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Street Address
Address Line 2
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State / Province
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Northern Mariana Islands
Ohio
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Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone of person filling out this form
*
Email of person filling out this form
*
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Confirm Email
Is the person listed above registering for the course?
*
Yes
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How many registrants?
*
One
Two
Three
More than eight
More than twelve
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Name of person registering for the course.
First
Last
Leave blank if you are filling out this form for yourself, if unknown or multiple registrants. Please explain in the comments section.
Course
*
Which course would you like to register for? Please include the start date of the course. Online registration does not guarantee a spot in the course. Prepayment is required. Conditions apply.
Comments
How did you hear about the clinic courses?
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This course requires proof of a {{PrerequisiteType}} in order to register. Please provide the documentation by using the upload button below.
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