nnnnCreate NEI account at httpsneiglobalCreateNewUser if you do not already have oneRENEWALMILITARY 1 year multiyear option not available 1 year multiyear option not available Military Studen ID: 898971
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1 n n n n Registration Form Create NEI acc
n n n n Registration Form Create NEI account at https://nei.global/CreateNewUser if you do not already have one RENEWALMILITARY* - 1 year (multi-year option not available) - 1 year (multi-year option not available) * Military, Students and Residents, see page 2 for requirements.REGISTRATION edentials: ional Provider Indenti er (NPI) #: Business Address: City, State, Zip: Phone: equired): NEI ID: Allow 1-3 business days for processing. If you do not receive an emailed con rmation within that time, please call PAYMENT METHOD (payable to Neuroscience Education Institute)Visa card American Expr Exp. Date: Veri cation #: Signature: Date: SUBMIT YOUR FORM BY:Attention: Membership NEI MEMBERSHIP Registration & Requirement InformationStudent, Resident, and MilitaryREQUIREMENTS FOR SPECIAL MEMBERSHIP RATESYou must be a full-time student, currently enrolled in 12* credit hours. Submit one of the following as proof of enrollment: cial transcript verifying current full-time enrollment om the registrar’s of ce or program director, verifying current full-time status. All letters must be on the institution’s letterhead and signed by either the registrar’s o
2 f ce or your program director.*If yo
f ce or your program director.*If your institution grants full-time status for fewer than 12 credits, provide a letter from your institution stating the number of credits for which it grants full-time status and the number of credits in which you are currently enrolled.Submit one of the following as proof of residency: oof of current enrollment in an accredited training program oof of current enrollment in a fellowship program he institution’s letterhead and signed by your program director, verifying current enrollmentMILITARY REQUIREMENTSMilitary rates are available to those on active duty, military veterans, as well as military, VA, and DoD employees. Submit one of the following as proof of military status: alid military, VA, or DoD identi cation REGISTRATION INFORMATION Create an NEI guest account online at www.neiglobal.com (if you don’t already have one). When prompted to join membership, select “No, not right now.”Complete the registration form on page 1 and submit it with the required documents (see requirements below). Once your information is processed, NEI will send a con rmation email.SUBMISSION INFORMATION: customerservice@neiglobal.com(760) 931-8713Carlsbad, CA 92008 Questions? NEI MEMBERSHIP