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Bleeding Control Registration May 25
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5
Questions
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HIPAA
Compliance
1
Name (Nombre)
*
This field is required.
First Name / Primer Nombre
Last Name / Segundo Nombre
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2
Phone Number / Telefono
*
This field is required.
Please enter a valid phone number.
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3
Email / Correo Electronico
*
This field is required.
example@example.com
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4
Class Language / Idioma de la Clase
*
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English
Spanish
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5
Select Class Time / Elige el Tiempo de su Clase
*
This field is required.
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6
Time
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Minutes
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