CLIA Surveyor National Training

CLIA Training Registration

Please fill out the following information.

First Name^*

Last Name^*

Email Address^* Enter the email address of the person that will be attending the training.

Confirm Email Address^*

Supervisor Name^*

Supervisor Email Address^*

CMS Location^*

State^*

Job Title

Which event would you like to attend?^*

CLIA National Meeting

Have you attended CLIA before?^*

Yes

If you answered "yes", indicate the year or years that you have attended:^*

2022

2021

How long have you been at your position?^*
If you have been at your position for more than 3-4 years, you will need to add an exception.