Atos Medical Registration

First Name *

Last Name *

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Credentials for Certificate *

Speech and Language TherapistMRCSLTM.A. - SLTM.S. - SLTPh.D. - SLTOther

List here if Other

Phone *

Email *

Training Options *

If you select a Hybrid Zoom Webinar or Live option, please choose your training date.Online Self-Directed CE Training (8 hours)Hybrid Zoom Webinar CE Training (4-hours Online/4-hours Webinar)Live, In-Person CE Training (8 hours) - Dates Pending

Hybrid: On-Demand + Zoom Webinar

Hybrid: Completion of the 4 hours of pre-work required.TBD - Summer, 2023: 2 - 4 PM BST each dayTBD - Fall, 2023: 2 - 4 PM BST each day

Affiliation *Trust, Company, or Facility Name

Additional Comments

Will you need ASHA CE Hours

You are an International Member of the American Speech & Hearing Association and you will submit these CE Hours for renewal.YesNo

List ASHA Number here if applicable:

Atos Medical Registration

Atos Medical CE Registration Form

Verification