2025 Jodie Williams Professional Learning Conference
Registrant Agreement & Session Track Selection

Friday, October 17, 2025

This form is STEP 1 in the registration process for the Jodie Williams Professional Learning Conference. After completing this form, please complete STEP 2 as outlined on the conference landing page.

Question Title

* Registrant Information:

Full Name:

Email Address (conference information will be sent to this address):

Licensure/ Certification
(ex: OT/PT/PTA):

County of Employment:

Question Title

* Registrant Agreement (please check off all statements)

I give permission to release my contact information and attendance records for this course to Howard Community College, the Maryland State Steering Committee for Occupational and Physical Therapy School-based Programs, the Maryland State Department of Education and the appropriate accrediting bodies for CEUs.

I understand that I must be logged on for the entire conference and must complete, at the designated times, the required pre- and post-tests in order to receive a CEU certificate.

I certify that I am the person described in this form and that the information presented is correct to the best of my knowledge: This certification constitutes my electronic signature.

2025 Jodie Williams Professional Learning ConferenceRegistrant Agreement & Session Track Selection

Friday, October 17, 2025

Question Title

* Registrant Information:

Question Title

* Registrant Agreement (please check off all statements)

2025 Jodie Williams Professional Learning Conference
Registrant Agreement & Session Track Selection