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 State
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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
PTA
PT
PA
MD / DO / DPM
License Number(s) Required for CE's
Issuing State
AL
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
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
DIGITAL SIGNATURE VERIFIES ACCURACY OF INFORMATION
Applicant Printed Full Name
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Date signed
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