DATA Waiver Training Registration

Please fill out all fields and upon completion, and scroll to the bottom of the page and click "Done" to submit your registration.

Please be aware that CME credits are not available for these trainings.

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* 1. First Name

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* 2. Last Name

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* 3. Work Email Address: please be sure that this is a valid and functional email.

You will receive connection information prior to the selected training date through this email.

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* 4. Provider Type

Physician

Physician Assistant

Nurse Practitioner

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* 5. Workplace Zipcode

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* 6. Does your facility currently offer Medication Assisted Treatment?

Yes

No

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* 7. Agency

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* 8. If IHS, Tribal, or Urban, what area do you serve? If not IHS, Tribal, or Urban, select "N/A."

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* 9. Please select the date you would like to register to attend:

April 23, 2019 from 9 AM to 1 PM MDT

June 10, 2019 from 11 AM to 3 PM MDT

Click "Done" to complete your registration.