• Username* Usernames cannot be changed.
• First Name*
• Last Name*
• E-mail*
• Password* Type your password.
  The password must have a minimum strength of WeakStrength indicator
• Repeat Password* Type your password again.
• Intern/License Information0000License #/ Intern # include Prefix (SW, MT or MH): (If you do not hold a Florida Intern or License number, please enter 0000.)
• Human Check*

• Send these credentials via email.