Community – Member Trainee Welcome to the Community-based trainee registration page. Community-based training modules are suitable for those who front line healthcare staff, those who serve our aging community in various capacities, or those who are likely to encounter individuals living with dementia and their caregivers. Name(Required) First Last Email(Required) Phone(Required)User Login DetailsUser access setup for on demand coursesUsername(Required) Password(Required) Enter Password Confirm Password Location DetailsAddress info:Location Details(Required) City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country DemographicsHow old are you?(Required)19 and under20-29 years30-39 years40-49 years50-59 years60 and overWhat is your gender?(Required) Male Female Prefer not to answer What is your race?(Required)American Indian / Alaskan NativeAsian/Asian AmericanHispanic/LatinxNative Hawaiian/Pacific IslanderBlack/African AmericanNon-Hispanic/WhiteMore than one raceOtherIf Other, Specify Race(Required) What is your ethnicity?(Required)Hispanic/LatinoNon-Hispanic/Non-LatinoOtherIf Other, Specify Ethnicity(Required) What is your educational degree or credentials?(Required)BachelorsMastersPhDPANPMD/DORNPharmDMSW/LCSWPhysical TherapyOccupational TherapyDDS/DMDAssociateCHWOtherIf Other, Specify Education Did you come from a disadvantaged background? (e.g. receive public assistance, food stamps, housing assistance)(Required) Yes No Did you live in a rural area during the majority of your childhood?(Required) Yes No What is your primary role?(Required)Health Professional / ProviderUniversity FacultyResidentFellowStudentOtherIf Other, Specify Primary Role(Required) Administrator(Required) Clinician(Required) Educator(Required) Researcher(Required) What is your current employment status?(Required)Full-TimePart-TimeOn LeaveStudentRetiredName of place of employment(Required)Cleveland Clinic Lou Ruvo Center for Brain HealthUniversity of Nevada Las Vegas Practice PlanWillima Bee Ririe ClinicNevada Adult Day Healthcare CenterUniversity of Nevada, Las VegasMission Pines Nursing & RehabVolunteers in Medicine of Southern NevadaOtherIf Other, Specify place of employment(Required) Please indicate your primary discipline. (e.g. family practice, specialty, sub-specialty, psychology, etc.)(Required) Employer Zip Code(Required) Have you ever served in the armed forces?(Required) Yes No Are you requesting CME/CEU for this course?(Required) Yes No Please contact us for any further details
