OREGON HLO Exam Registration

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Certification / Practice Information

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Examination*

You must check the box below to register for the examination.

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OREGON HLO Exam Registration

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Certification / Practice Information

List License and/or Certification Number(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Practice Specialty {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Institution / Business Where Practicing (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Website URL (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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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 }
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Comments or Questions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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OREGON HLO Exam Registration

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

Certification / Practice Information

List License and/or Certification Number(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Practice Specialty {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Institution / Business Where Practicing (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Website URL (if applicable) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

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 }
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Comments or Questions {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Cognito Forms{{ Cognito.resources["powered-by-cognito"] }}