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Registration

Registration is FREE and is required to access the courses offered by this site.  Fields with the asterisk (*) symbol are required to be filled out in order to register.  Once you have registered, you will use your EMAIL and PASSWORD you created to log in on the home page.

  *required field
*Email:
*Create a Password:
  password must be 6-20 characters in length
*Re-type Password:
 
*First Name:
*Last Name:
*Degree (MD/DO, Etc):
Title:
*Practice Name:
*Address Line 1:
Address Line 2:
*City:
*State:
*Zip:
Phone:
Fax:
AAP Member Number:
Illinois Medicaid Provider ID number:
Type of Clinic/Practice:
National Provider Identification (NPI) Number:

To be eligible for reimbursement from the Illinois Department of Healthcare and Family services, primary care providers must submit their Medicaid License Number.

*Enter the characters
in the security image:
  
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