2007 | Vol 12 No 3 | JAVA | 165

DOI: 10.2309/java.12-3-14

Continuing Education FormMark the one answer that bestagrees with the course content.

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EvaluationDid the articles meet the courseobjectives? Yes ■ No ■

Is the home study format an effec-tive way to present this material?Yes ■ No ■

Is the content relevant to your prac-tice? Yes ■ No ■

Comments _______________________________________________________________________________

Suggestion for future topics______________________________

Length of time required to completethis program? ____________

Accreditation Provider approved by the CaliforniaBoard of Registered Nursing,Provider Number CEP12371 for onecontact hour.

HOW TO EARN CONTINUING EDUCATION CREDIT

1. Read the two continuing education articles (also available online).2. Complete the post-test and record your answers on this Continuing

Education Form. Note that you can use this printed form or you canaccess the form online (you will need to print the form out and completethe questions on the hard-copy print-out).

3. Complete the registration information and the course evaluation includ-ed on this Continuing Education Form.

4. Mail or fax the completed Continuing Education Form with your $10.00fee - check or money order (payable to AVA) or credit card information(VISA, MasterCard, American Express, or Discover).

Name ______________________________________________________

Address ____________________________________________________

City ______________________________ State _____ Zip ___________

Phone: ( ____ ) ________________ Email ________________________

Social Security Number __ __ __ - __ __ - __ __ __ __

RN License Number and State of License:___________________________________________________________

Method of Payment ($10.00 fee required)■ Money Order or ■ Check made payable to AVA enclosed. ■ Please bill my credit card ■ VISA ■ MasterCard■ American Express ■ Discover

Credit Card Number _____________________________Expiration Date ___________ Three-digit Security Code _____

Signature ___________________________________ Date ___________

Mail: Association for Vascular Access (AVA)134 Fairmont Street, Suite BClinton, MS 39056

Fax: 601-924-0720 (credit card payments only)

To earn 1 contact hour of continuing education, you must achieve a scoreof 70% (7 of 10 correct). If you do not pass the test, you may take it oneadditional time at no additional charge before the published deadline. Testresults will be sent to you within 21 days of receipt of ContinuingEducation Form in our administrative office. A certificate indicating suc-cessful completion of this offering will bear the date your ContinuingEducation Form is received.

Please call 877-924-AVA1 or601-924-2233 if you haveany questions.

http://www.avainfo.orgSubmission must be postmarked by February 1, 2008.