1. Profile Information

Thank you for taking the time to complete the application below for ASHA CEUs. You must provide your full name, address, telephone number, email address and ASHA Member Number.  ATIA needs to pass this information to ASHA for posting into an individual's ASHA CE Registry.

Please note that you must have been a registered attendee after July 1, 2019 and have viewed the webinar recording in order to answer the quiz questions, which are based on the learning objectives. 

Question Title

* 1. Please fill in your demographic data.

Question Title

* 2. Please add your ASHA Member Number: