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Required fields are marked with an asterisk (*).

1. Please enter your full name and professional designation as you would like them to appear on your certificate (e.g., Meredith Grey, MD).
2. Time Zone
3. Country
4. Language
5. Please select your group type:
6. Paramedic/EMT License Number (required for CAPCE credit)
7. Paramedic/EMT License Type (required for CAPCE credit)
8. Paramedic/EMT State of License (required for CAPCE credit)
9. Paramedic/EMT License Expiration Date (required for CAPCE credit)
10. Paramedic/EMT NREMT License Number (if applicable)
11. Paramedic/EMT NREMT Renewal Date (if applicable)
To sign up to application press button with label "Sign Up".

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