*1.Please Indicate the Date for Registration (A Teams calendar invite will be sent a day before the orientation):(Required.)

Thursday, July 16, 2026 at 12 PM-1 PM CT

2.Practice or Provider Name:

*3.Practice Tax ID Number:(Required.)

4.Practice NPI:

5.Provider Type (e.g., Hospital, DME Provider, Waiver Provider, Behavioral Health Provider, Primary Care Provider):

6.Number of Attendees:

7.Attendee Name and Role:

8.Office/Contact Phone Number:

*9.Email Addresses for Attendees:
(Please review your email addresses for accuracy, as any errors may delay your training.)
A Microsoft Teams invite will be sent one day prior to the session, after registration is complete.(Required.)