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User registration

Please complete this form to register for inclusion in the Health Education Directory. After you submit the form, you will receive an email with a link to create your password and login to the directory. From your dashboard, you will be able to modify your profile and add programs for inclusion in the Directory.

Account Information
A valid email address. All emails from the system will be sent to this address. The email address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by email.
Several special characters are allowed, including space, period (.), hyphen (-), apostrophe ('), underscore (_), and the @ sign.
University Information
Name of University
One file only.
1 MB limit.
Allowed types: png gif jpg jpeg.
Contact Information
Department chair first name
Department chair last name
Name of Department
Your position
Department phone number
Email address for inquiries
Address
Enter the address for the Department
CAPTCHA
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