Researcher-Academic Town Meeting and ASHA Approved CE Provider Workshop RSVP Form

November 13, 2013, 5:15 p.m. to 9:30 p.m.
ASHA Convention, Chicago, Illinois

We are pleased that you are interested in attending the special combined Researcher-Academic Town Meeting and ASHA Approved CE Provider workshop. This year's topic is "Interprofessional Education: Moving Toward a Collaborative Era through Preprofessional Education and Lifelong Learning." Barbara Brandt, Ph.D. Associate Vice President of Education for the University of Minnesota's Academic Health Center and Director of the National Center for Interprofessional Practice and Education will provide a lecture and keynote address, followed by a panel discussion.

Please complete and submit this form by October 15, 2013. This popular event is by invitation only. Due to limited seating, we kindly request that you RSVP only if you will attend this event and stay for the duration. Reservations are accepted on a first-come first-served basis. You will receive an email detailing the status of your reservation within a week of submitting your registration form.

If you have questions, please contact ce-ratmworkshop@asha.org.

*First name:

*Last name:

ASHA Account Number:

*Email address:

Institution:

ASHA Approved CE Provider name:

If an ASHA Approved CE Provider, please insert the Provider code:

*Position (check all that apply):

Description

Area of Expertise (check all that apply): 

Other Area of Expertise:

Are you a 2013 recipient of any of the following awards or programs? (check all that apply):

 Dietary needs (check all that apply):

I give ASHA permission to share my contact information with Pearson so they can contact me about the University Alliance Program. University Alliance Program (UAP) provides valuable support for the teaching needs of college and university faculty and training directors. Membership in the UAP gives you and your students direct experience with some of today's most widely used assessments.