Please print your registration form and mail in with your payment to:Delaware Association for Home and Community Care PO Box 7037Wilmington DE 19803 Nursing Contact Hours available. Contact Hours pending for PT and OT.(all other disciplines curriculum and certificate availability only)Space is limited, capacity is limited to 100 attendees per session. Registration is first-come, first-served.Must be registered and payment received by webinar deadline. See individual webinar announcement for deadlines.CEU certificates, or curriculum and certificates will be sent via email – please provide a working email address. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Attendee InformationName *FirstLastAddress *Address Line 1Address Line 2CityChoose OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *TitleEmployerProfessional Licensure / Certification please check one: *RNLPNPTPTAOTCOTASLPMSWNHAOther CEU Certificate NeededYes I Need a CEU certificateCurriculum and Attendance Certificate NeededYes, I Need a CurriculumYes I Need an Attendance CertificateYour License NumberWebinar Selections1. Chronic Pain Initiative using Integrative Nurse CoachingMember – $ 21.00Non-Member – $ 26.00(1hr = 1CEU) Speaker: Karen Avino, EdD, RN, AHN-BC, HWNC, BC. Date: Tuesday, January 19, 2021 Registration & Payment Deadline: January 13, 2021 Time: 12:00 – 1:00pm2. Don’t be a Victim – Mitigating Damages in Violent SituationsMember – $ 36.00Non-Member – $ 42.00(2hr = 2CEU) Speaker: Carol Faedkte, RN, BSN, MI, CFRN Date: Tuesday, January 26, 2021 Registration & Payment Deadline: January 20, 2021 Time: 9:00-11:00am3. Palliative Care for Children with Severe Neurologic ImpairmentMember – $ 21.00Non-Member – $ 26.00(1hr = 1CEU) Speaker: Juliana O’Brien, MSN, FNP, BC Date: Thursday, February 11, 2021 Registration & Payment Deadline: February 5, 2021 Time: 12:00-1:004. From Stuck to Empowered – Managing Momentum Through Trying TimesMember – $ 21.00Non-Member – $ 26.00(1hr = 1CEU) Speaker: Cody Byrns Date: Tuesday, February 23, 2021 Registration & Payment Deadline: February 17, 2021 Time: 12:00-1:005. Sign up for all 4 webinars at once (15% Discount)Member – $ 85.00Non-Member – $ 102.00(5hr = 5CEU) Registration & Payment Deadline: January 13, 2021 WEBINAR DATES Jan 19, 2021 – Chronic Pain Initiative using Integrative Nurse Coaching. Jan 26, 2021 – Don’t be a Victim – Mitigating Damages in Violent Situations. Feb 11, 2021 – Palliative Care for Children with Severe Neurologic Impairment. Feb 23, 2021 – From Stuck to Empowered – Managing Momentum Through Trying Times.Total Payment Due:$ 0.00Comments or Questions:NameSubmit