WOUND CARE EDUCATION INSTITUTE
SKIN AND WOUND MANAGEMENT COURSE
ONSITE COURSE ONLY REGISTRATION
STEP 2 OF 3
APPLICANT INFORMATION
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ONSITE (week long in classroom)
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Course Start Date
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You ARE eligible for the early rate! Ensure that you select "EARLY RATE" during the payment process.
You ARE NOT eligible for the early rate. Ensure that you select "STANDARD RATE" during the payment process.
ONLINE (90 day home study)
LICENSE INFORMATION
Required for CEs
Professional Licenses
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LPN / LVN
RN
NP / APN
OT
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PT
PA
MD / DO / DPM
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License Number(s) Required for CE's
Issuing State
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AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
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DIGITAL SIGNATURE VERIFIES ACCURACY OF INFORMATION
Applicant Printed Full Name
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Date signed
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