Thank you for your interest in the NY/NJ AETC training event.
Event Title:Oral Cancer Premalignant Lesions - Video
We collect information from each participant in our training activities using the Participant Information Form (PIF). To complete your registration, please follow the instructions below to create or update your Participant Information Form (PIF).
Please fill in your PIF Unique ID Number. Use the month of your birth, day of your birth, and last four digits of your SSN. For example, May 29, 123-345-6789, has the ID number 05296789. Why is this necessary This program is part of the New York/New Jersey AIDS Education and Training Center, a federally funded training program.  Because of the government funding source, we need to account for every person who receives training, as well as the number of people who attend multiple trainings.  Please note that this unique identifier does not allow for identification of individual respondents.  As indicated on the form, please create your anonymous PIF unique identification number by entering the month and day of your birth, and the last 4 digits of your Social Security number.

M M D D # # # #
Birth Last 4 SSN
First Name:    * required
Last Name:    * required
Email:    * required