By American CME / July 31, 2023 Home > Alliance Mobile Health – Oakland Alliance Mobile Health - Oakland County Admin Enrollment Only This form is for the group leader. Providers (group members) are enrolled by the Group Leader. First Name:* First Name Required Last Name:* Last Name Required Email:* Email is Required License Type (Select From Dropdown Menu):* License Type (Select From Dropdown Menu) is Required EMR/MFREMTEMT-BEMT-IntEMT-PParamedicPCPAEMTCFROther State Issued (Select From Dropdown Menu):* State Issued (Select From Dropdown Menu) is Required AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingOther State EMS # (Required for CAPCE and State CE): State EMS # (Required for CAPCE and State CE) is not valid Date of expiration (Month day, year)(Required with State EMS #): Date of expiration (Month day, year)(Required with State EMS #) is not valid NREMT # (Leave BLANK if none. This means, do not put any abbreviations or words in this field. Simply leave the field empty if you do not have an NREMT number.): NREMT # (Leave BLANK if none. This means, do not put any abbreviations or words in this field. Simply leave the field empty if you do not have an NREMT number.) is not valid NREMT Re-registration Date (Required if NREMT # is provided): NREMT Re-registration Date (Required if NREMT # is provided) is not valid Agency Name (Providing the agency name does not automatically enroll you in the agency account.): Agency Name (Providing the agency name does not automatically enroll you in the agency account.) is not valid Your City of Residence:* Your City of Residence is Required State of Residence (Select From Dropdown Menu): State of Residence (Select From Dropdown Menu) is not valid AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginaWashingtonWest VirginiaWisconsinWyomingNone Zip Code:* Zip Code is Required Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger This site collects names, emails and other user information and never sells user information. By agreeing to this policy, you consent to the terms set forth in the Privacy Policy. If you are taking CAPCE accredited courses, you additionally understand that American CME will submit a record of your CAPCE course completions to the CAPCE AMS. You further understand that course completion records may be accessed by or shared with such regulators as state EMS offices, training officers, and NREMT on a password-protected need-to-know basis. In addition, you understand that you may review your record of CAPCE accredited course completions by contacting CAPCE. No val Please fix the errors above Login
