ALAMO HEAD INJURY CONFERENCE REGISTRATION FORM

Click the "Print Page" button, then complete the form, enclose a check or money order, and mail both to:
Alamo Head Injury Association
P.O. Box 29074
San Antonio, TX 78229-0074
Please use the following rates:
Individual Rate - $85
Group Rate - $75/ea.
Name:
Address:
City:
State:
Zip:
Ph:
Bus. Ph:


7.2 Credit Hours
If applicable, please choose Credit Hour Requirement below:

University Health System is an approved provider of continuing nursing education by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This activity meets Type I criteria for mandatory continuing education requirements toward re-licensure as established by the Board of Nurse Examiners for the State of Texas. Attendees will need to attend the program in its entirety to receive 7.2 credit hours (Approval Pending) for SW, LPC, Nurses,Case Managers & CRC.
Social Work
Last four of your SSN ____________
Licensed Professional Counselor
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Nurses
Last four of your SSN ____________
Case Managers
Last four of your SSN ____________
7.2 Credit Hours (Approval Pending) for SW, LPC, Nurses, & Case Managers