Pre-registration Form

RADIATION PROTECTION OFFICE

	EHS/RPO Event Pre-Registration Form
	*1. Please select a type of event (i.e. Lab Safety Training)*

Training type:

*required

2. Please select an available session date/time

	Available sessions:

3. Please fill-in the information below (required)

	BMC/BUMC ID#( from your ID card, No SSN allowed):
	First Name:
	Middle Initial:
	Last Name:
	Email:
	Phone:
	Department:

PLEASE NOTE:

-DO NOT register online unless you have a valid BMC id number. Your registration will not be processed correctly if you enter an invalid number.