New Registration Form

Please fill out the information below. Please note that all fields are required.

Company Information
Company Name
Parent Company Name
Address Line 1
Address Line 2
City
State
Zip
Contact Info
First Name
Last Name
Title
Email
Phone Number
with area code
General Information
Your answers to either the Agency Information or the Industry Information (but not both) are required.
Agency Information
Size of US healthcare practice Single Practitioner
2-25 employees
26-49 employees
50-99 employees
100+
Industry Information
Business Focus Pharmaceuticals
Biotechnology
Devices
Diagnostics
Other
Relative size of company globally More than 50,000 employees
10,001 - 50,000
1,001 - 10,000
100 - 1,000
Less than 100 employees
Certification (check one):
Public Relations   Advertising   Promotional Medical Education
Number of Registrants for Basic Test only
Number of Registrants for Advanced Test only
(Note: must have passed Basic to take Advanced)
Number of Registrants for both Basic & Advanced Tests
Training: Regulatory Compliance 101: Public Relations
I am interested in learning more about the course. Please send me the curriculum.
Telephone Consulting and On-site Customized Instruction with Regulatory Experts
I am interested in learning more about the consulting and on-site customized instruction offerings. Please contact me to discuss the options further.
Customized Reports
I am interested in learning more about customized reports on test results that are available to support staff development (e.g., for annual reviews).
Diagnostics
I am interested in CCC audits of the internal processes of companies and agencies, and in the development of customized recommendations for creating a culture of compliance throughout the organization.
Licensing of Regulatory Compliance Test (RCT) and 3-Part Course (Industry Only)
I am interested in learning more about how the Regulatory Compliance Tests and Regulatory Compliance 101 Web-based training courses are available for licensing.
  

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