Registration for DoC Opening Your Consciousness
Attendee Type
Please select an attendee type.
Non Memorial Hermann Employee
Memorial Hermann Employee
(If so, you must register with your Memorial Hermann E-mail address)
Registration Information
First Name (as it will appear on course certificate)
*
Last Name (as it will appear on course certificate)
*
Credentials (as it will appear on course certificate)
*
Email
*
Verify Email
*
Select your discipline (click all that apply)
*
OT/OTA
PT/PTA
SLP
Nurse
SW
CM
MD
DO
Pharmacist
PhD
ATC
LAT
Student
Other
Date of Birth (MM/DD)
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Date of Birth (MM/DD)
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Date of Birth (MM/DD)
*
Discipline - Other
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Professional License Number (as it will appear on course certificate)
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Professional License Number (as it will appear on course certificate)
*
ASHA number (as it will appear on course certificate)
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Professional License number
*
Do you want to receive ASHA CEUs?
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Yes
No
Degree (as it will appear on course certificate)
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Degree (as it will appear on course certificate)
*
NABP#
*
Date of Birth (MM/DD)
*
Professional License Number (as it will appear on course certificate)
*
Professional License Number (as it will appear on course certificate)
*
Employer Location
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Katy Rehab Inpatient
Katy Rehab Outpatient
MH Home Health
MH Southeast
MH Southwest
MH TMC
Non-MHHS
Other MHHS Location
SM&R Location
TIRR (Medical Center)
TIRR Challenge, Kirby Glen
TIRR Challenge, The Woodlands
TIRR Greater Heights
TIRR Kirby Glen
TIRR Memorial City
TIRR Sugarland
TIRR Woodlands OP
TIRR Woodlands, IP
Receive email communications, including marketing communications, from Memorial Hermann Health System via email or text. (Text charges may apply.)
*
Yes
No
How did you hear about this course? You may select more than one answer.
Email
AOTA
LinkedIn
APTA
Facebook
Colleague
TIRR Journal
Other
Email Registration Assistance
