Application: Associate Hyperbaric Nurse

For RNs and LPNs with a certificate of completion for the IBHBOT Introduction to Hyperbaric Medicine course.

Legal name (must match your photo ID)(Required)

Prefix First Last Suffix

Email(Required)

Phone(Required)

Mailing address(Required)

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

Training site(Required)

Instructor name(Required)

Course completion date(Required)

License(Required)

License number(Required)

Issuing state or authority(Required)

License expiration date(Required)

Certificate of completion, Introduction to Hyperbaric Medicine(Required)

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Copy of current nursing license(Required)

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Current BLS card(Required)

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Government-issued photo ID(Required)

Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB.

Testing accommodations requested (optional)