Continuing Education Registration Form

Registration Details

• Registration Type New Registration
• User Name: @uhems.com
• Password Selection:
   
• Confirm Password:

• Department Name:
• Certification Number:
• Certification Expiration:

Personal Information

• First Name:
• Last Name:
• Address:
• City:
• State:
• Zip Code:
• Email Address:
• Confirm Email Address:
• Phone Number:

• Permission: I hereby give UH EMS Institute permission to contact me periodically.