Affiliation Information Section Notes:

Below you will be asked for your hospital affiliation. If you choose anything other than "Independent / Other", you will need to select an affiliation from the main menu above after you submit your account information.  
  • This affiliation allows the appropriate pricing and billing policies to be applied.
  • If you select an Affiliation of Centura, Exempla or Health One your EmployeeID, Facility, Department and Manager Name is required.

Contact Information

Required fields are denoted by *--. You are in the Contact Information section. Continue to tab below to start reading or entering your information.
* Relationship
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Please select Individual
Must contain an uppercase, three lowercase, a digit and a non-alphanumeric character (e.g. $ @ # %). Example "Abbbxx1#".

Dr. Rt. DO, PA, Other
Provider
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Can now be used to claim AHA Certifications
Selecting a provider enables text messaging. We use text messaging for class communications only.

Non work email is preferred

Primary Address

--. You are in the Primary Address section. Continue to tab below to start reading or entering your information.
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Affiliation Info

Required fields are denoted by *--. You are in the Affiliation Info section. Continue to tab below to start reading or entering your information.
* Hospital\Employer Affiliation
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* Facility
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Please see instructions at top of page
Select "N/A-Other" if not applicable
Enter "N/A" if not Centura, Exempla, or Health One

Card Status

Required fields are denoted by *--. You are in the Card Status section. Continue to tab below to start reading or entering your information.
* Current Card Status
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Applies to BLS, ACLS and PALS classes only
Enter "N/A" if Never Taken