OREGON HLO Exam Registration
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Certification / Practice Information
List License and/or Certification Number(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Practice Specialty {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Institution / Business Where Practicing (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Website URL (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Examination*
You must check the box below to register for the examination.
I attest that I have been approved in writing (or by email) by the State of Oregon HLO to take this examination, and have met all of the HLO's requirements. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
Comments or Questions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{{ Cognito.resources["powered-by-cognito"] }}