Call Eden II Today!
If you have questions about how to fill out this form, please click here.
Extension (If necessary)
Start Time of Event
End Time of Event
Event Address (For Live In-Person Workshops Only)
Are ASHA CEUs offered? (If yes, flyer must include ASHA brand block, financial, & non-financial disclosure) YesNo
How many ASHA CEUs are being offered?
Enter details from ASHA Administrator here:
Jan Downey must be notified that ASHA CEUs will be offered for this course. Please contact her, and check the box below to confirm that she has been notified. (Jan Downey can be reached at email@example.com or 516-937-1397 x524) Yes, Mary has been notified
What Is/Are The Financial Disclosure(s)?
What Is/Are Non-financial Disclosure(s)?
Are BCBA CEU's offered? (If yes, disclaimer & logo must be included on the flyer) YesNo
How many BCBA CEUs are being offered?
Enter details from BCBA Administrator here:
Marissa Bennett must be notified that BCBA CEUs will be offered for this course. Please contact her, and check the box below to confirm that she has been notified. (Marissa can be reached at 516-937-1397 x617 and firstname.lastname@example.org) Yes, Marissa has been notified.
Are Social Work CEUs offered? YesNo
How many Social Work CEUs?
Has Patricia been notified? YesNo
Total Cost including CEUs (required)
Is the event being paid for with a grant? YesNo
Description of event (please include a 2-4 sentence abstract of the proposed webinar)
Upload an abstract (Optional, PDF file format only)
Event objectives (please include 2-5 webinar objectives for attendees)
Title of Presenter as it will appear on the ad:
Company Presenter is employed by:
Who is the target audience? (i.e.:SLPs, Parents, Behavior Analysts, etc.)
Moderator to record event for future use? YesNo