Attendance Form - Pointing to Safety Series

Pointing to Safety Attendance Form

Fill out and submit within 48 hours after the webinar ends. Attendance during the event will be cross-referenced with this form.

ACU Webinar CME Form

Please select which panel you attended

Panel 1: Understanding How Malpractice Claims Happen (5/15)

Panel 2: Risk Management For Acupuncture Clinics (6/12)

Panel 3: Risk Management With Herbal Prescribing (July)

If you select a panel you did not attend, or has not occurred, you will not receive credits.

I am requesting the following continuing education credits:

2 Category 1 California Acupuncture Board CEUs (live credits only)

2 NCCAOM Safety PDAs (we will submit for you)

Check all that apply

California Acupuncture License Name

First

Last

California Acupuncture License #

CAB Certificate Email

Email address in which to send the CAB certificate.

NCCAOM Diplomate Name

First

Last

NCCAOM ID #

NCCAOM Email

Email address used with NCCAOM Diplomate account.

Phone #

Will only be used if we need clarification for submitting CE credits.

Zoom Display Name (Optional)

If you attended the webinar using a Zoom account that doesn’t match your name, please put it here so we can verify your attendance.