Get Registration Form

Completing the Registration Form online is a straightforward process that ensures you can participate in the Mayo Clinic Nicotine Education Program effectively. This step-by-step guide will help you navigate through each section of the form with clarity and guidance.

Follow the steps to successfully complete your registration.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Fill in your registrant name, including your first name, middle name or initial, and last name.
3. Specify your degree and company affiliation, along with your work/business address that includes the street address, city, state or province, ZIP or postal code.
4. Provide your home phone number and work phone number, including the area code for both.
5. Enter your email address and your birth date in the format Month DD, YYYY.
6. Indicate your Hispanic ethnicity by selecting either 'Hispanic or Latino' or 'NOT Hispanic or Latino'.
7. Select your sex by choosing either 'Male' or 'Female'.
8. Identify your racial group from the provided options and specify if you choose 'Other'.
9. State your primary specialty and current position from the list provided.
10. Review the registration dates and fees, ensuring you select the appropriate options.
11. Complete the payment information section by indicating if a check is enclosed and the payment total.
12. After completing all sections, save your changes. You may also choose to download, print, or share the form as needed.

Take the next step towards your professional development by completing the Registration Form online today.