* 1. What is your first name?

* 2. What is your last name?

* 3. What is your mailing address?

* 4. RN License Number (for CEU Credit)

* 5. What is your e mail address? (We will contact you through this e mail)

* 6. Occupation Information:

* 7. Please enter a cell number for us to contact you regarding last minute class information if needed:

* 8. May we text you?

* 9. Other (Please specify)

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