ILINet Training Registration Tool

This form is used to register for the Florida Department of Health's Influenza-like Illness Surveillance Network (ILINet) introduction and training program.

This training program is a web-based program. After you have registered using this form, you will receive an e-mail with details about how to access the program and how to obtain Continuing Education Units (CEUs) if you are eligible.

If you have any questions about this training program, or do not receive an e-mail within a week, please contact us at

Prefered Title:

First Name:

Middle Name:

Last Name:

Degrees (such as MD, DO, RN, PhD, etc.), list all that apply:

License Number (the license number for which you would like to receive CEUs if applicable, be sure to include prefix):

Employment Location (clinic name, hospital name, etc.):

Employment Address (street address, city, state, and zip code):

Mailing Address (only if different from employment address, include: name, street address, city, state, zip code):

E-mail address:

Primary Phone Number (include area code)

Secondary Phone Number (include area code):

Fax Number (include area code):

What is your prefered method of communication if we have questions for you?

How did you hear about this training program (select all that apply)?

Thank you for your interest in the Florida Department of Health's ILINet program!

You will be contacted shortly regarding this training. If you have any questions in the meantime, please e-mail us at