Register - Honoring Choices PNW

Create Your Account

This registration form is intended for those who are going through our Serious Illness Conversation Guide (SICG) training, or have completed one of our other trainings, such as Respecting Choices First Steps Facilitator Certification.

Name*
First Last
Organization*

If you were trained through a different organization than the one you work for, please list them in parenthesis [eg: Washington Hospital (Washington Medical Group)]
Title
Credentials

(e.g. MD, DO, NP, PA, SW)
Role in Advance Care Planning*

eg: ACP Coordinator, Instructor, Facilitator, ACPlanner, SICG, SICG Teacher
Email*
Phone
Hidden
Phone Number
Username*
Password*
Enter Password Confirm Password

Strength indicator
Comments
This field is for validation purposes and should be left unchanged.