ASHA CE Registry Form

Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.

In order to retrieve your ASHA number, or to pay ASHA their CE Registry fees, call ASHA’s Action Center at (800) 498-2071.

 

Before you complete this form, you MUST record your CE minutes for the SHAA convention.  Your initial registration helped us to plan rooms and seating, but does not report your CE time.  To do so, follow the link on the SHAA Home page for CE Time Reporting.

Lastname Firstname Middlename *

Last First Middle with one space between each (e.g., Joe Don Schmoe = Schmoe Joe Don)

ASHA ID Number *

(must be 8 digits)

Primary Phone *
Email *
Which session did you find most surprising, and why? *

(Your response is subject to approval by SHAA.)

Tell the most memorable thing(s) you learned. *

(Your response is subject to approval by SHAA.)

What concrete steps can you now take to implement what you learned? *

(Your response is subject to approval by SHAA.)




  Yes! Please send me news from SHAA.



Your form submission WILL be encrypted using SSL to ensure your privacy.

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