Register – OptiEd2

First Name

Last Name

Costco E-mail Address

Password

Confirm Password

Employee Number

License

ABO License#

NCLE License #

COPE Number

Alaska Certificate #

Arizona Certificate #

Arkansas Certificate #

Connecticut Certificate #

Florida License #

Georgia Certified

Hawaii Certificate #

Kentucky Certificate #

Massachusetts Certificate #

Nevada Certificate #

New Jersey Certified

New York Certificate License #

North Carolina Certificate #

Ohio License#

Rhode Island Certificate #

South Carolina Certificate #

Tennessee Certificate #

Texas Certificate #

Vermont Certificate #

Virginia Certificate #

Washington Certificate #

West Virginia Certificate #

Only fill in if you are not human