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Florida Strategic National Stockpile Mass Dispensing Course Registration


All participants must complete the registration form prior to taking the Florida Strategic National Stockpile and Mass Dispensing Course.


NAME:


ORGANIZATION:


TYPE:




COUNTY:


JOB TITLE:


STREET ADDRESS:


CITY:


ZIP CODE:


STATE:


EMAIL ADDRESS:


AREA CODE:


DAY TIME PHONE NUMBER:


LICENSE TYPE:














LICENSE NUMBER:


Note: If you will be requesting continuing education credit for this course, please print your completed registration form prior to submitting.

If you have questions, please feel free to contact Division of Emergency Medical Operations, Office of Emergency Operations at 850.245.4040 or email FLMassDispensingCourse@doh.state.fl.us

Mailing Address:
Office of Emergency Operations
4052 Bald Cypress Way A22
Tallahassee, FL 32399
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