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Group Course Registration

  1. Has the instructor been contacted?

  2. Does your group's insurance carrier provide accident insurance and worker's compensation coverage for the participants?

  3. Is this course DOH Continuing Education eligible?

  4. Level of Program

  5. DOH Continuing Education Pre-Approved

  6. DOH Continuing Education Applied for By

  7. Leave This Blank:

  8. This field is not part of the form submission.