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Continuing Education FormMark the one answer that bestagrees with the course content.
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3, a,O b,O c,O d,O
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EvaluationDid the articles meet the courseobjectives? Yes 0 NoO
Is the home study format is aneffective way to present thismaterial' Yes 0 NoO
Is the content relevant to yourpractice' Yes 0 NoO
Comments
Suggestion for future topics
Length of time required to com-plete this program? _
AccreditationProvider approved by theCalifornia Board of RegisteredNursing, Provider NumberCEP12371 for one contact hour.
Please call 877-924-AVAl or601-924-2233 if you haveany questions.
http://www,avainfo,org
HOW TO EARN CONTINUING EDUCATION CREDIT
1, Read the two continuing education a.ticles (also available online),2, Complete the post-test and record your answers on this Continuing
Education Form, Note that you can use this printed form or youGm access the form onJine (you will need to print the form Outand complete the questions on the hard-copy print-out),
3, Complete the registration information and the cOLlI'se evaluationincluded on this Continuing Education Fonl1,
4, Mail or fax Ule completed Continuing Education Form with yOLlI'$10,00 fee - check or money order (payable to AVA) or credit cardinformation (VISA, MasterCard, American Express, or Discover)
Name
Address _
City State __ Zip
Phone: ( __ ) Email _
Social Security Number - __ - _
RN License Number and State of License:
Method of Payment ($10,00 fee reqUired)o Money Order or 0 Check made payable to AVA enclosed,o Please bill my credit card 0 VISA 0 MasterCardo American Express 0 Discover
Credit Card Number _Expiration Date _
Signature Date
Mail: Association for Vascular Access (AVA)134 Fairmont Street, Suite BClinton, MS 39056
Fax: 601-924-0720 (credit card payments only)
To earn 1 contact hour of continuing education, you must achieve ascore of 70% (7 of 10 correct), If you do not pass the test, you maytake it one additional time at no additional charge before the published deadline, Test results will be sent to you within 21 days ofreceipt of Continuing Education Form in our administrative office, Acertificate indicating successful completion of this offering will bearthe date your Continuing Education Form is received,
Submission must bepostmarked by February 1, 2007.
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2006 Vol 11 No 3 .JAVA 153
