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Our LMS requires that everyone – including people who have taken trainings in the past – establish themselves in the system. This includes completing demographic data that is compiled only for reporting purposes and not associated with individual users. Once you have registered in the LMS, the next time you log in with your user ID and password, subsequent event registrations will be abbreviated and event specific.
* Required Fields
First Name
*
Last Name
*
Degrees
Position
*
Agency
*
Division
Address *
Address
City *
State*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
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Hawaii
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Ohio
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code *
Work Phone
Email
*
This must be a valid email address
Is this your first training/event offered by us?
*
Yes
No
DEMOGRAPHIC INFORMATION (compiled only for reporting purposes, not associated with individual users)
Your Date of Birth:
*
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February
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1912
1911
1910
1909
1908
1907
1906
1905
Only Year is Required
Gender
*
Male
Female
Transgender
Ethnicity
*
Hispanic
Non-Hispanic
Race
(check all that apply)
*
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Asian
White/Caucasian
Black/African American
Which of the following
best
describes your profession / occupational classification?
*
Biostatistician
Commnty Health Wrkr
Consumer
Dentist
Elected Gov’t Official
Emer Mgmnt/BT Prep
Environmental Health
Epidemiology
Health Admin
Health Info Systems
Health Promotion/Education
Home Health Aide/Medical Assistant
Laboratory Sciences
Law Enforcement
Mental Health/Substance Abuse
Nurse
Nutritionist/Dietician
Pharmacist
Physician
Physician Assistant
Psychologist
Public Health Law
Public Health Policy
Sanitarian/REHS
Social Worker
Support Staff (admin asst/clerk)
Teacher/Faculty
Veterinarian
Other
Which is your employment location type?
*
Academia
Federal Government
State Government
City-County Govt/Local Health Dept.
Indian Health/Tribal Government
Hospitals
Community-Based/Non-Profit
Private Industry
Other
Employment Setting
*
Urban
Rural
Frontier
At which of the following sites do you regularly work?
(check all that apply)
*
(Designated) Ambulator Practice Site
Hospital/University Health Center
Public Housing Primary Care Grantee
Community Health Center CHC
Indian Health Service Site
Rural Health Clinic
Federally Qualified Health Center (FQHC)
Migrant Health Center
State or Local Health Department
Health Care for the Homeless Grantee
Health Professional Primary Care Grantee
Other
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