2024 Continuing Education Registration Form

2024 Continuing Education Registration Form
Are you an Ivy Rehab Teammate?*

YesNo
Name*

First NameLast Name
Discipline*
Email*
* If Ivy teammate, please use Ivy email address example@example.com
If using your CE Allowance, please use coupon code, IVYTEAMMATE, when checking out. This will zero out the cost of the course, and the cost will come directly from your CE allowance.
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Region/Clinic*
License State*
License Number*
State License Number
Secondary License Number
State License Number
Secondary License State
ASHA ID #
Do you want your information submitted to ASHA CE to earn ASHA CEUs or receive a certificate of completion

Yes, please submit my information to ASHA CENo, I only want a certificate of completion
BCBA Certification Number
If using your CE Allowance, please use coupon code, IVYTEAMMATE, when checking out. This will zero out the cost of the course, and the cost will come directly from your CE allowance.

Course List*

Cari Ebert

NOV - Cari Ebert: The Nuts and Bolts of ApraxiaNovember 22, 2024 VIRTUAL

$100.00 Quantity

Enter coupon

Total

$0.00

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If using your CE Allowance, please use coupon code, IVYTEAMMATE, when checking out. This will zero out the cost of the course, and the cost will come directly from your CE allowance.
APTA Member ID Number
Are you an APTA Member?

YesNo
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