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PeriFACTS® Online Continuing Education Program
Registration Form – One-Year Subscription

 * - Required Field.

Order Information

Contact Person: * Hospital: Job Code: *
Phone Number: Fax Number: Email Address: *
Street Address: * Street Address Line 2: Confirm Email Address: *
City: * State: * Zip Code: *
Country: * How did you hear about us? Subscription Type: *
License Number (Individuals Only): * Program Type (Individuals Only): *  
Groups will be contacted after purchase for group information including license numbers and program type selection for each participant

Subscription Types

Credit Type No. of Participants
CNE Contact Hours: $109.00 each    
CME Credit: $159.00 each    
Total number of participants: 0
Subscription Total: $0.00
Group Discount: ($0.00)
Promo Discount: ($0.00)
Total Cost: $0.00
Total Participants Order Discount
50-99 5% off
100-499 10% off
500+ 20% off

Promo Code (Optional)


Payment Information

Payment Type: