CE Certificate Payment Form - NAADAC

CE Certificate Payment Form

Thank you for your desire to earn Continuing Education Credits through NAADAC's Life-Long Learning Webinar Series!

Members of NAADAC or AccuCare Subscribers who participate in a webinar (archived or live event) are eligible to receive a Certificate of Completion for 1.5 CEs for FREE. Non-members of NAADAC or Nonsubscribers of AccuCare receive 1.5 CEs for $20. All applicants for CE credit are required to complete the "CE Quiz" after the presentation and submit it to NAADAC for grading, along with the processing fee, if applicable. A CE certificate will be emailed to you within 21 days.

Steps: 1) Watch an eligible webinar listed at webinars. 2) Pass the associated CE Quiz for the webinar. Your score is automatically transmitted to NAADAC for verification and validation. ? NAADAC members/AccuCare subscribers: Nothing more is needed from you to receive your certificate. 3) Non-members of NAADAC/Non-subscribers of AccuCare: Submit payment of $20 (if necessary) to NAADAC online or by submitting this payment form to NAADAC by mail, fax or email. ? Mail: NAADAC, 1001 N. Fairfax Street, Suite 201, Alexandria, VA 22314 ? Fax: 703.741.7698 ? Email: naadac@ 4) Your Certificate of Completion will be emailed to you within 21 days of processing.

Questions or problems? Contact NAADAC at naadac@.

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Title of Webinar____________________________________________________________________________

Name_____________________________________________________________________________________

Address___________________________________________________________________________________

City_________________________________________________State______________Zip________________

Phone (___________)___________________________Fax (__________)______________________________

Email_____________________________________________________________________________________

o I am a member of NAADAC or an AccuCare subscriber or recently joined. (Don't submit this form) o I am not a current member of NAADAC or AccuCare subscriber ($20 Due)

o Check enclosed, payable to "NAADAC" o Charge my o Visa o MC o AmEx

Card #____________________________________________ Expiration Date_______________________

Signature_______________________________________________________________________________

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