register.gotowebinar.com
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Submitted URL: http://click.email.ngsmedicare.com/?qs=d770d953c5d22afb8a369c326590c9fd2f9c641c7cec1d6944e0e1361936c487b018602eacfaaded08d0020020ec...
Effective URL: https://register.gotowebinar.com/register/6461601555121649423
Submission: On September 02 via manual from US
Effective URL: https://register.gotowebinar.com/register/6461601555121649423
Submission: On September 02 via manual from US
Form analysis 1 forms found in the DOM
<form id="registrationForm" data-view="registration/body/body" data-active-view="true" style="">
<div data-bind="visible:!webinarTimesVM().allSessionsOver()" class="trainingTimesBox clearfix">
<!-- ko compose : { view : 'registration/body/body.webinarTimes' } -->
<div data-view="registration/body/body.webinarTimes" data-active-view="true" style="">
<!-- ko 'if' : showDates() === true -->
<hr>
<!-- ko 'if': !getWebinarInfo().description --><!-- /ko -->
<!-- ko 'if' : getWebinarInfo().type === 'series' --><!-- /ko -->
<!-- ko 'if' : getWebinarInfo().type !== 'series' -->
<div data-bind="'visible': getWebinarInfo().type === 'sequence'" class="row col-md-12" style="display: none;">
<div data-bind="'html': multipleSessionsText">This webinar meets 1 times.</div>
</div>
<div class="row col-md-12">
<div id="training-times" class="trainingTimesRegister">
<table class="webinarTimes" data-bind="'foreach': webinarTimesVM().webinarSessions()">
<tbody>
<!-- ko 'if' : $parent.webinarTimesVM().showFirstOfMonth($data) && $parent.getWebinarInfo().type === 'sequence'--><!-- /ko -->
<tr data-bind="css:{'past':past && !$data.inSession, 'next':next, 'future':future, 'far-future':farFuture}" class="next">
<!--ko 'if': $data.getDay() && $parent.getWebinarInfo().type === 'sequence' --><!--/ko-->
<td data-bind="'text':$data.getStartAndEndDate()">Tue, Sep 7, 2021 8:00 PM - 9:00 PM CEST</td>
</tr>
</tbody>
</table>
</div>
</div>
<!-- /ko -->
<div class="row col-md-12">
<a class="timeZone pointer launch-tz-modal" data-i18n="registration.webinarTimes.timeZone" data-bind="click:webinarTimesVM().showInMyTimeZoneDialog">Show in My Time Zone</a>
<!-- ko 'if' : webinarTimesVM().priceInfo --><!-- /ko -->
</div>
<!-- /ko -->
<!-- ko 'if' : showDates() === false && webinarTimesVM().priceInfo --><!-- /ko -->
</div><!-- /ko -->
</div>
<!-- ko 'if': getWebinarInfo().description -->
<!-- ko compose : {view:'registration/body/body.description'} -->
<div data-bind="visible:getWebinarInfo().description" data-view="registration/body/body.description" data-active-view="true" style="">
<hr>
<div class="description trainingDescription">
<div class="clearfix">
<img id="customThemeImage" data-bind="attr:{src:getBrandingInfo().themeImageUrl}" class="customImage" onerror="this.style.display='none'" src="https://images.gotowebinar.com/e60e8dc535363f765b1385ad94c5f9f7">
<span class="registration-description" data-bind="expander:{'expandText': moreButtonText(), 'userCollapseText': lessButtonText(), 'text':getWebinarInfo().description}">Join us for a walkthrough of our newly designed NGSMedicare website.
During this session, we will provide an overview of the new website layout, guide you through the many resources available for you, and address any questions you have. Please join us to see all of the information NGSMedicare has available
right at your fingertips. </span>
</div>
</div>
</div><!-- /ko -->
<!-- /ko -->
<!-- ko compose : {view:'registration/body/body.registrationQuestions'} -->
<div class="questions" data-view="registration/body/body.registrationQuestions" data-active-view="true" style="">
<hr>
<!-- General Questions -->
<p class="requiredMessage" data-i18n="registration.registrationQuestions.requiredInstructions">Required field</p>
<div id="studentInformation">
<div data-bind="'foreach':registrationQuestionsVM().groupedGeneralQuestions">
<div data-bind="'foreach':$data" class="row">
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.firstNameLabel" for="registrant.firstName">First Name</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.firstName" maxlength="128" tabindex="2">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.lastNameLabel" for="registrant.lastName">Last Name</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.lastName" maxlength="128" tabindex="3">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
</div>
<div data-bind="'foreach':$data" class="row">
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.emailLabel" for="registrant.email">Email Address</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' -->
<input type="email" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.email" maxlength="128" tabindex="4">
<!-- /ko -->
<!-- ko 'if' : name !== 'email' --><!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.addressLabel" for="registrant.address">Street Address</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.address" maxlength="128" tabindex="5">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
</div>
<div data-bind="'foreach':$data" class="row">
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.cityLabel" for="registrant.city">City</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.city" maxlength="128" tabindex="6">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.stateLabel" for="registrant.state">State/Province</label>
<!-- ko 'if': type == 'shortAnswer' --><!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' -->
<select class="form-control maxCharLimit"
data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'options':answers, 'optionsText':'answer', optionsCaption:$root.chooseOneText, value:selectedAnswer, optionsValue:'answerKey'"
id="registrant.state" tabindex="7">
<option value="">Choose One...</option>
<option value="None">None</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Virgin Islands">Virgin Islands</option>
<option value="Guam">Guam</option>
<option value="Alberta">Alberta</option>
<option value="British Columbia">British Columbia</option>
<option value="Manitoba">Manitoba</option>
<option value="New Brunswick">New Brunswick</option>
<option value="Newfoundland">Newfoundland</option>
<option value="Northwest Territories">Northwest Territories</option>
<option value="Nova Scotia">Nova Scotia</option>
<option value="Nunavut">Nunavut</option>
<option value="Ontario">Ontario</option>
<option value="Prince Edward Island">Prince Edward Island</option>
<option value="Quebec">Quebec</option>
<option value="Saskatchewan">Saskatchewan</option>
<option value="Yukon">Yukon</option>
</select>
<!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
</div>
<div data-bind="'foreach':$data" class="row">
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.zipCodeLabel" for="registrant.zipCode">Zip/Postal Code</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.zipCode" maxlength="128" tabindex="8">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.phoneLabel" for="registrant.phone">Phone Number</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.phone" maxlength="128" tabindex="9">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
</div>
<div data-bind="'foreach':$data" class="row">
<div class="form-group col-sm-6 required" data-bind="'css':{required : required, 'has-error':verificationFailed }, visible:name != 'comments'">
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'registrant.' + name}, 'text':question" id="registrant.organizationLabel" for="registrant.organization">Organization</label>
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, 'visible':isSelected, 'css':{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit"
style="display: none;">128</span>
<!-- TODO : IE8 Doesn't allow to change type of input field-->
<!-- ko 'if' : name === 'email' --><!-- /ko -->
<!-- ko 'if' : name !== 'email' -->
<input type="text" data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'registrant.' + name, 'maxlength':maxSize, 'tabindex':tabIdx}, 'hasFocus':isSelected, 'value':selectedAnswer, 'valueUpdate': 'afterkeydown'"
class="form-control maxCharLimit" id="registrant.organization" maxlength="128" tabindex="10">
<!-- /ko -->
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<!-- ko 'if': verificationFailed --><!-- /ko -->
</div>
</div>
</div>
</div>
<!-- Custom Questions-->
<!-- ko 'if': registrationQuestionsVM().customQuestions().length > 0 -->
<hr class="skinny">
<div class="alert-info">
<p data-i18n=""></p>
</div>
<div class="row" data-bind="'foreach':registrationQuestionsVM().customQuestions">
<div class="form-group col-sm-12" data-bind="'css':{required : required, 'has-error':verificationFailed}">
<!-- ko 'if' : question -->
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'customQuestion' + $index()}, 'html':question" id="registrant.234687269Label" for="customQuestion0">Please enter your NPI, if known</label>
<!-- /ko -->
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, visible:isSelected, css:{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit" style="display: none;">128</span>
<input data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'customQuestion' + $index(), maxlength:maxSize, tabindex:tabIdx}, hasFocus:isSelected, value:selectedAnswer, valueUpdate: 'afterkeydown'"
class="form-control maxCharLimit" type="text" id="customQuestion0" maxlength="128" tabindex="11">
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<span data-bind="visible:verificationFailed" class="help-block" style="display: none;"><i class="togo-icon togo-icon-error"></i><span data-bind="'text':errorMessage"></span></span>
</div>
<div class="form-group col-sm-12" data-bind="'css':{required : required, 'has-error':verificationFailed}">
<!-- ko 'if' : question -->
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'customQuestion' + $index()}, 'html':question" id="registrant.234687270Label" for="customQuestion1">Please enter your PTAN or provider number, if
known.</label>
<!-- /ko -->
<!-- ko 'if': type == 'shortAnswer' -->
<span data-bind="'text':maxSize - selectedAnswer().length, visible:isSelected, css:{'danger':maxSize - selectedAnswer().length === 0, 'warning':maxSize - selectedAnswer().length < 20}" class="charLimit" style="display: none;">128</span>
<input data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'customQuestion' + $index(), maxlength:maxSize, tabindex:tabIdx}, hasFocus:isSelected, value:selectedAnswer, valueUpdate: 'afterkeydown'"
class="form-control maxCharLimit" type="text" id="customQuestion1" maxlength="128" tabindex="12">
<!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' --><!-- /ko -->
<span data-bind="visible:verificationFailed" class="help-block" style="display: none;"><i class="togo-icon togo-icon-error"></i><span data-bind="'text':errorMessage"></span></span>
</div>
<div class="form-group col-sm-12 required" data-bind="'css':{required : required, 'has-error':verificationFailed}">
<!-- ko 'if' : question -->
<label class="control-label" data-bind="'attr':{'id':'registrant.' + name + 'Label', 'for':'customQuestion' + $index()}, 'html':question" id="registrant.234687271Label" for="customQuestion2">Please indicate the jurisdiction you bill Medicare
beneficiary claims for:</label>
<!-- /ko -->
<!-- ko 'if': type == 'shortAnswer' --><!-- /ko -->
<!-- ko 'if': type == 'multipleChoice' -->
<select class="form-control maxCharLimit"
data-bind="'css':{'inputError': verificationFailed}, 'attr':{'id':'customQuestion' + $index(), tabindex:tabIdx},hasFocus:isSelected, options: answers, optionsText:'answer', optionsCaption:$parent.chooseOneText, value:selectedAnswer, optionsValue:'answerKey'"
id="customQuestion2" tabindex="13">
<option value="">Choose One...</option>
<option value="234687272">Jurisdiction 6 Part A Home Health & Hospice, Federal Qualified Health Center</option>
<option value="234687273">Jurisdiction 6 Part B</option>
<option value="234687274">Jurisdiction K Part A Home Health & Hospice, Federal Qualified Health Center</option>
<option value="234687275">Jurisdiction K Part B</option>
<option value="234687276">Other Jurisdiction or areas of business</option>
</select>
<!-- /ko -->
<span data-bind="visible:verificationFailed" class="help-block" style="display: none;"><i class="togo-icon togo-icon-error"></i><span data-bind="'text':errorMessage"></span></span>
</div>
</div>
<hr class="skinny">
<!-- /ko -->
<!-- ko 'if' : registrationQuestionsVM().commentsField --><!-- /ko -->
</div><!-- /ko -->
<div class="paymentBody" id="payment-form" data-bind="visible: showPayment" style="display: none;">
<!-- ko 'if' : registrationQuestionsVM().commentsField || registrationQuestionsVM().customQuestions().length == 0 --><!-- /ko -->
<div class="paymentFields" data-bind="visible: showCreditCardFields" style="display: none;">
<div clss="row">
<div class="card-disclaimer">
<i class="togo-icon togo-icon-lock-closed"></i>
<span class="stripe-text" data-i18n="registration.cardDisclaimer">Secured payments with your credit or debit card via stripe</span>
<span class="cards-icons">
<img src="../../../../images/visa.png">
<img src="../../../../images/masterCard.png">
<img src="../../../../images/amex.png">
<img src="../../../../images/discover.jpg">
</span>
</div>
<!-- Used to display form errors. -->
<div id="card-errors" role="alert"></div>
</div>
<div id="paymentBody-paymentRequest">
<!-- Stripe paymentRequestButton Element inserted here-->
</div>
<div class="row">
<div class="field card-number col-xs-12 col-sm-6 col-md-6 col-lg-6">
<label class="control-label" for="card-number" data-i18n="registration.creditCardNumber">Card Number</label>
<div id="card-number" class="field empty input payment-fields">
<!-- A Stripe Element will be inserted here. -->
</div>
</div>
<div class="field card-expiry col-xs-6 col-sm-3 col-md-3 col-lg-3">
<label class="control-label" for="card-expiry" data-i18n="registration.expirationDate">Expiration Date</label>
<div id="card-expiry" class="empty input payment-fields">
<!-- A Stripe Element will be inserted here. -->
</div>
</div>
<div class="field card-cvc col-xs-6 col-sm-3 col-md-3 col-lg-3">
<label class="control-label" for="card-cvc" data-i18n="registration.cvv">CVV</label>
<div id="card-cvc" class="empty input payment-fields">
<!-- A Stripe Element will be inserted here. -->
</div>
</div>
</div>
<div class="error" role="alert">
<svg xmlns="http://www.w3.org/2000/svg" width="17" height="17" viewBox="0 0 17 17">
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</form>Text Content
NGSMEDICARE WEBSITE WALKTHROUGH AND OPEN Q&A The email address you're registering with is already in use. Please register using an alternate email address. -------------------------------------------------------------------------------- This webinar meets 1 times. Tue, Sep 7, 2021 8:00 PM - 9:00 PM CEST Show in My Time Zone -------------------------------------------------------------------------------- Join us for a walkthrough of our newly designed NGSMedicare website. During this session, we will provide an overview of the new website layout, guide you through the many resources available for you, and address any questions you have. Please join us to see all of the information NGSMedicare has available right at your fingertips. -------------------------------------------------------------------------------- Required field First Name 128 Last Name 128 Email Address 128 Street Address 128 City 128 State/Province Choose One...NoneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingPuerto RicoVirgin IslandsGuamAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Zip/Postal Code 128 Phone Number 128 Organization 128 -------------------------------------------------------------------------------- Please enter your NPI, if known 128 Please enter your PTAN or provider number, if known. 128 Please indicate the jurisdiction you bill Medicare beneficiary claims for: Choose One...Jurisdiction 6 Part A Home Health & Hospice, Federal Qualified Health CenterJurisdiction 6 Part BJurisdiction K Part A Home Health & Hospice, Federal Qualified Health CenterJurisdiction K Part BOther Jurisdiction or areas of business -------------------------------------------------------------------------------- Secured payments with your credit or debit card via stripe Card Number Expiration Date CVV Enter your card details Discount Code Apply Invalid discount code. Discount code applied successfully! NOTE: Please direct all payment-related questions to the webinar organizer. Your registration for this webinar is subject to LogMeIn’s Terms of Service and Privacy Policy. -------------------------------------------------------------------------------- Unfortunately your browser isn't supported. Please upgrade to Safari v7+ or switch to Chrome™ or FireFox®. By clicking this button, you submit your information to the webinar organizer, who will use it to communicate with you regarding this event and their other services. Register ©1997-2021 LogMeIn, Inc. All rights reserved. View the GoToWebinar Privacy Policy Firefox is a registered trademark of the Mozilla Foundation. To review the webinar organizer's privacy policy or opt out of their other communications, contact the webinar organizer directly. Safeguarding your email address and webinar registration information is taken seriously at GoToWebinar. GoToWebinar will not sell or rent this information.