La soumission de votre formulaire dûment rempli génère une demande de licence qui vous permettra d’effectuer les divers modules Hemispheres. Notez que vous serez dirigé vers l'administrateur du site approprié, qui sera votre contact habituel.
Last name of registrant
1st (or given) name of person being registered
Enter email of person being registered
Please enter the same email address again
Enter another email address
Name of the organization, business, or hospital registrant works for. Please be sure to CLICK on your selection
Position within the Health Care System the registrant works for. Please be sure to CLICK on your selection
Where on the continuum of care best describess where the person being registered usually works? Please remember to CLICK on your selection.
Please provide the first name of Manager, Shift Scheduler, or Edu Coordinator
Please provide the last name of Manager, Shift Scheduler, or Edu Coordinator
Email of Manager listed above
I am interested in completing the full Hemispheres program
I am only interested in the NIH Stroke Scale portion.
You can upload a signed Memorandum of Agreement if you wish
Once form is fully filled out, click here to submit registration.