Form Instances

Account Information

* Legal First Name

Legal Middle Name

* Legal Last Name

Suffix

* Email

Alternate Email

* Daytime/Primary Phone

Mobile Phone

Date of Birth

* Mailing Address Line 1

Mailing Address Line 2

* City

* State

* Country

* Postal Code

Password

Password Confirmation

Additional Information

* Last 4 SSN

*Enter 0000 if you are an international student

* Sex

* Race/Ethnicity

* I would like to receive BOC communication regarding future specialty certifications via email.

* I would like to receive BOC communication regarding BOC orthopedic specialty certification via email.

NATA Membership #

Military Status

Do you have a disability or a history/record of having a disability?

* The BOC offers Candidate and Certified Athletic Trainer mailing lists to other organizations such as BOC Approved Providers. I would like my mailing address and email address to be available to these organizations.

* The BOC offers Candidate and Certified Athletic Trainer telephone lists to other organizations such as NATA. I would like my phone number(s) to be available to these organizations.

* Which of the following best describes the practice setting at your primary practice location?

* Display City/State/Country in Certification Directory?

* Enable SMS/Text Reminders

Yes

* CAATE Accredited Program

* I give my consent to collect, retain and use my customer data in accordance with the BOC's Privacy Policy

I agree