2023 Registration - TEST page | UNCLCN Learning Portal

Email *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Prefix

First Name *

Middle Name

Last Name *

Preferred Pronouns

Street *

Additional

Country *

Country Other

State/Province *

Postal Code

Primary Profession

Primary Profession Other...

Credentials *

What degrees and credentials would you like listed after your name?

Phone Number

To receive lecture notices via text message (please include area code) — US only

What Continuing Education Credit type are you interested in? *

(If you do not see your CE credit type listed, please select "Other" and let us know what credits to offer in future courses)

What Continuing Education Credit type are you interested in? Other

UNC Affiliate Status *

UNC Affiliate Status Other (please list affiliation)

Highest Degree Earned *

What is your NABP Monitor Number? *

Required for ACPE certificate.

What is your ASRT Number? *

Required for ASRT Certificate

Date of Birth *

Month

Day

Year

Employer or Organization *

Employer or Organization Other

Would you like to sign-up to receive our monthly Newsletter and webinar updates? *

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2023 Registration - TEST page