Information Session Registration

Sessions are about one (1) hour in length.

* = Required Field

Semester You Intend to Enroll * Summer 2022 Fall 2022

Session Date * Medical Billing and Coding – Tuesday, May 17, 2022 @ 6PM in Room H-124

First Name *

Middle Name or Initial

Last Name *

Address *

Apartment/Unit

City *

State * Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

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Alternate Phone

Gender * Male Female I Choose not to Respond

Last 4 digits of Social Security Number *

Birthdate

Email *

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