Registration FormPlease fill in the form below to register.First Name *Last Name *Use proper capitalization as this is how it will appear on your certificate should you choose to become certified.Email *Confirm Email *Your Current Phase *Please Select One...High SchoolUndergraduateMed School Year 1 or 2Med School Year 3+Practicing Medical ProfessionalField of Intereste.g. GP, Dental, Nursing, Physician Assistant, EMT, Physiotherapy, Pediatrics, etc)Where did you find out about Future Doctors' Academy?e.g. Facebook, friend, or whatever...I already have an Apprentice Doctor Simulation KitCheck this if you were directed to this website after acquiring one of the Apprentice Doctor Simulation KitsUsername *Password *Confirm Password *Weak PasswordPassword not enteredStrength Indicator1
