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Continuing Education Program Certificate Form – 2023

Please complete all fields. The Name field must match the Registered Name in attendance at the event in order to receive the Program Certificate. It will be emailed to the Email address entered.

  • Please rate the program you attended today, rating each presentation on a scale of 1 (Poor) to 4 (Excellent):
  • Susan E. Martin RN, PhD AOCN
  • Korrina Lau, MSN, FNP-BC, AOCNP
  • Teresa Knoop, MSN, RN, AOCN
  • Nicolette Chun, MS, LCGC
  • Charina Tosti, MSN, FNP-BC, AOCNP
  • Kelly Burgos, MS, RN, ANP-BC
  • Michael Gensheimer, MD
  • Selinza Mitchell, Clinical Nurse Educator
  • This field is for validation purposes and should be left unchanged.