1. Registration Information

Please complete this registration for a free 90-day trial of "E-dition," the on-line version of the Joint Commission's Behavioral Health accreditation manual. All questions with an * are required.

Instructions for activating your free trial will be emailed to you after your registration has been received. For questions related to this form, please e-mail mlehman@jointcommission.org

PLEASE NOTE: This free trial is limited to organizations seeking accreditation or certification, or those requiring or recognizing accreditation, including payers and State authorities.

If you are currently Joint Commission accredited, please contact your accreditation manager to review your organization's free manual; if you wish to purchase an additional manual, they are available at jcrinc.com

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First Name

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* 1. First Name

Last Name

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* 2. Last Name

Title

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* 3. Title

Organization Name

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* 4. Organization Name

Street Address

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* 5. Street Address

City

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* 6. City

Zip Code

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* 8. Zip Code

Telephone Number

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* 9. Telephone Number

Email address:

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* 10. Email address:

Would you like us to contact you to provide assistance?

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* 11. Would you like us to contact you to provide assistance?

Which of the following best describes your organization's status? (check all that apply)

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* 12. Which of the following best describes your organization's status? (check all that apply)

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