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CME Registration CME Registration First Name* Last Name* Address* City, State Zip* , Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia 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 Work Phone Home Phone Cell Phone Email* Certification Level* Select... EMT-P EMT-CC EMT-I EMT-B CFR Other NYS Certification #* Course To Register* Select... ACLS2008 ACLS2009 AMLS2008 AMLS2009 PEPP2008 PEPP2009 PHTLS2008 PHTLS2009 AWR Training Geriatric Lecture Second Saturday Medical Rounds Payment Method* Select... Check payable to Bassett Healthcare for $150.00 at beginning of class I am eligable to participate in the CME recertification program VIEW ELIGBILITY GUIDELINES Comments Enter your first name Enter your last name Enter your address Second address line if needed Enter your city Select your state Enter your zip code Enter your work phone Enter your home phone enter your cell phone Enter your email Select your certification level Enter your New York State certification number Click here to submit your application enter any comments you may have select your payment method please select the course you would like to register for