AHLS My Account Page

Please complete all profile information to create an account.
**NOTE** The name on your certificate will appear EXACTLY as entered.

My Profile Information

		Required Field
Title
First Name
Last Name
Email Address
Gender	Male Female
Birth Date	Month Day Year
Primary Profession
Secondary Profession
Are you a Board Certified Toxicologist?	Yes No
Employer
Where did you hear about us?
Subscribe to Newsletter?	Yes No
For EMS Professionals Only
In order for AHLS to process any applicable continuing education credits for your course, please provide the following information for any license(s) with expiration date(s) that you may have. I understand that AHLS as a requirement of CAPCE accreditation will submit a record of my course completions to the CAPCE AMS. I further understand that my course completion records may be accessed by or shared with such regulators as state EMS offices, training officers, and NREMT on a password-protected need-to-know basis. In addition, I understand that I may review my record of CAPCE-accredited course completions by contacting CAPCE. By completing the course registration, I acknowledge that I have read this statement and agree to allow the processing of any applicable continuing education credits that I may be eligible for.
State Licensed
License Number
License Expiration Date
NREMT Number
NREMT Reregistration Date
For Pharmacists Only
In order for AHLS to process any applicable continuing education credits for your course, please provide your NABP number here and your Birth Date in the above "My Profile Information" section (MM/DD required).
NABP Number
Home Address Information
Home Street
Home Street 2
Home City
Home State(USA/CA only)
Home Province(Excl USA/CA)
Home Postal Code(USA xxxxx or xxxxx-xxxx)
Home Country
Home Phone(USA xxx-xxx-xxxx)
Work Address Information
Work Street
Work Street 2
Work City
Work State(USA/CA only)
Work Province(Excl USA/CA)
Work Postal Code(USA xxxxx or xxxxx-xxxx)
Work Country
Work Phone/Ext(USA xxx-xxx-xxxx)	/
Login Information
Your email address is recommended for a user name. Otherwise, a unique name at least 6 characters long is required.
User Name
Password
Verify Password		Please type your password again for verification
		Required Field

Cancellation Policy:

The Advanced Hazmat Life Support International Headquarters and the course sponsor reserves the right to cancel this program for any reason. If a program is cancelled all registrants will be notified a minimum of 14 days prior to the course and all tuition paid will be refunded. AHLS, the Arizona Emergency Medicine Research Center, and The University of Arizona accept no responsibility or liability for any non-refundable airfare or other arrangements made.