Board Member Registration

Name(Required)

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Email(Required)

Phone

Username

Choose a username that is recognizable such as first initial and last name. No spaces or special characters. Maximum of 15 characters.

Password

This will be your password to login to the site. Make sure you remember it.

Enter Password Confirm Password

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I Am Requesting Access As A:(Required)

Board Member

What Is Your Company Name?

I Am A Member Of These Organizations:(Required)

ASHI

NACHI

KREIA

None

Address

Street Address Address Line 2 City State ZIP / Postal Code Country

OH License Number

License Expiration Date

OREIA Membership Type(Required)

Board Member Membership

Have a coupon?

Enter coupon code exactly how it appears and click apply. Once applied it will not ask for any of your card information except your name.

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Credit Card

If you're using a coupon, a message will appear here saying "The credit card field will initiate once the payment condition is met". That means it's working, next just type in the card holder name and submit. Also if you're using a coupon, email parker@cognificent.org when you are finished so your account can be activated.

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Membership ID

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Expiration Date

Board Member Registration

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