Create an Account

Logos

Biological & Chemical Warfare and Terrorism - Medical Issues and Response

Create an Account

Fill out the following form. This form serves both Site Administrators and Participants. Click the Submit button when completed.

Required Fields are indicated in RED. Fields marked with * may be required.

Personal Information
Enter this information carefully as it determines how your name will appear on official records such as CEs and other certificates.
Title (Mr., Mrs., etc.)
First Name
Middle Initial
Last Name
Suffix (Jr., III, MD, etc.)

Mailing Address
NOTE: do not add your organization's name in the address, just the street address. The name of your Employer is asked later.
Mailing Preference	Home Work
Address	No PO Boxes Please. If necessary, put PO Box in Address2.
Address2
City
State
Country
Postal Code

Contact Information

Please enter your Email Address correctly so that you can be kept informed about changes to events or sites where you are enrolled.

Re-Type Email

Work Phone
(Ext. not req.)

Area Code	Phone Number	Ext.

Fax

Area Code	Fax Number

Employment Information
Professional Category
Name of Employer
The following two fields are only required if you selected "work" as your mailing preference.
Department *
Job Title *

Login Information
This information will be used to log into our system to access your records. The Hint will be displayed in the event you forget your password. [more info]
Username	Maximum 30 characters
Password	Maximum 30 characters
Confirm Password
Password Hint
Security Question
Answer

Other
If you have any special needs that you would like an Event Coordinator or Site Administrator to have knowledge of when you are attending an event, enter them here.
Special Needs

NOTICE If you click the submit button more than once you will get a duplication error. If you receive this error, try logging in using the information you submitted and enroll in the broadcast from your account page. You may also receive this error if the username you chose is already taken by another registrant.

Mini FAQ

How do I specify a PO box in my mailing address?

Why is my e-mail address needed?

Why is my mailing address needed?

Who has access to my Personal Account information?

What is the Password Hint and Security Question used for?

View Entire FAQ