NameFirstLastCourse TitlePayment TypeEmailREHS Number (Note if registering with no REHS number or from out-of-state, please use 5000.)Your Phone NumberCan Your Phone Number be used for texting?NC County Health Depts & Districts (If retired, unaffliated or other employment, denote as NA and go to the next box.)OtherSupervisor’s NameSupervisor’s Phone NumberCan Your Supervisor’s Phone Number be used for texting?
NameFirstLastCourse TitlePayment TypeEmailREHS Number (Note if registering with no REHS number or from out-of-state, please use 5000.)Your Phone NumberCan Your Phone Number be used for texting?NC County Health Depts & Districts (If retired, unaffliated or other employment, denote as NA and go to the next box.)OtherSupervisor’s NameSupervisor’s Phone NumberCan Your Supervisor’s Phone Number be used for texting?