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WebinarWorkshop
Your Name
Your Email
Phone
Extension (If necessary)
Today's Date
Event Date
Department
Event Title
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?
Please provide time ordered agenda:
Mary Bainor 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. (Mary can be reached at Mbainor@eden2.org or 516-937-1397 x524) Yes, Mary has been notified
Are BCBA CEU's offered? (If yes, disclaimer & logo must be included on the flyer) YesNo
How many BCBA CEUs are being offered?
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 mbennett@eden2.org) Yes, Marissa has been notified.
Total Cost including CEUs (required)
What Is/Are The Financial Disclosure(s)?
What Is/Are Non-financial Disclosure(s)?
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)
Presenter's Name:
Upload Headshot
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
Additional Information
