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Licensed AAPC Instructor Application

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Personal Information

* First Name:
* Last Name:
* Member ID #:
* Mailing Address:
* City:
* State:
* Zip:
* Email:
* Phone Number:
Fax:

Coding Experience

* Employer:
* Employee Title:
* Employment Dates:
From: To:
* Supervisor:
Name: Phone:
Add Additional Work Experience

Instructional Experience

Institution/Course:
Number of Students:
Dates:
Add Additional Instructional Experience
Additional Information:
 
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