Wake AHEC Duplicate CE Credit Certificate
Request
Credit card payment
is required, secured, and confidential. We accept American
Express, VISA, MasterCard, and Discover. Please
have your credit card ready. A Wake AHEC customer service
representative will process your request. If you have any questions
or concerns, please call 1-866-341-1814 (toll free) or (919) 350-8547 during
business hours: 9am - 4pm (US, Eastern Time), Monday - Friday.
To help us find your record, please enter your information on this
form.
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*Required Fields |
Program
Information |
*Date of Program: |
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*Name of Program: |
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* Required Fields |
Your Information |
*Name: |
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Salutation: |
Mr.
Mrs.
Ms.
Dr.
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*Degrees/Certifications: |
If not applicable, enter NA.
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*Home address: |
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*City: |
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*State: |
*Zip:
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*Phone (Home): |
()
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*Occupation: |
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NABP e-Profile ID: |
Pharmacists and Pharm Techs only |
Birth - MMDD: |
Pharmacists and Pharm Techs only |
Employer: |
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County of Work: |
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Work address: |
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Work City: |
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Work State: |
Work Zip:
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Phone
(Work): |
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Ext.
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Fax (Work): |
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Would you like to receive program announcements? |
Check to receive announcements |
Email (Home or Office): |
Valid Email address required |
*How did you
hear about Wake AHEC?
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How do you prefer to receive your certificate?
(check one only) |
Fax
(7-10 business days)
Mail
to my home (7-10 business days)
Mail
to my work (7-10 business days)
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