Registration Please fill out the form below to gain access to the educational program(s). Items with an * are required fields. User Name* Password* Enter Password Confirm Password Name* First * Last * Credentials * Name of Employer Address* Street Address Street Address 2 City State State*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Enter Email Confirm Email PhoneDegree*Your degree*MDDORNNPPAPharmDRRTRPhAPNOtherOther, please specify* Type of Credit Claiming*Type of credit claiming*CME Credit (MD or DO)CNE Credit (Nursing)CPE Credit (Pharmacists)Certificate of CompletionNursing License* State(s) Licensed In*Use 2 digit abbreviation please. What is your NABP Number* What is Your Date of Birth* MM slash DD slash YYYY How did you hear about this program?*How did you hear about us?*Professional association/industry e-newsletter/emailProfessional association/industry social media postProfessional association/industry websiteProfessional association/industry print journalMinnesota Department of Health e-newsletter/emailMinnesota Department of Health or Quit Partner social media postMinnesota Department of Health or Quit Partner websiteMeeting or conferenceWord of mouth/personal communicationOtherOther, please specify* PhoneThis field is for validation purposes and should be left unchanged.