ceu self report sheet & certificate of completion...

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Page 1 of 3 INSTRUCTIONS FOR FORM COMPLETION: 1. Complete the demographic data section of this form. 2. For each activity you complete, enter the "Contact Hours Earned" in the appropriate column. 3. Place the total number of hours and CEUs earned in the spaces provided. One CEU equals ten contact hours. 4. Print out a copy, scan and email back to [email protected] or fax to 1.714.463.4673. 5. NSGC will email you a CEU certificate that will serve as your final proof of credits earned. Full Name (First, Middle, Last): Company Name: Email Address: Genetic Counselor CEUs: This event has been submitted to the National Society of Genetic Counselors (NSGC) for approval of Category 1 CEUs. The American Board of Genetic Counseling (ABGC) accepts CEUs approved by NSGC for purposes of recertification. Approval for the requested CEUs and Contact Hours is currently pending. CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION Genetics and Genomics Virtual Conference, May 11-12, 2016 (plus on-demand period)

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Page 1: CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION …public.labroots.com/public/files/web_files/general/CEU-Certificate... · CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION Genetics

Page 1 of 3

INSTRUCTIONS FOR FORM COMPLETION: 1. Complete the demographic data section of this form.2. For each activity you complete, enter the "Contact Hours Earned" in the appropriate column.3. Place the total number of hours and CEUs earned in the spaces provided. One CEU equals ten contact hours.4. Print out a copy, scan and email back to [email protected] or fax to 1.714.463.4673.5. NSGC will email you a CEU certificate that will serve as your final proof of credits earned.

Full Name (First, Middle, Last):

Company Name:

Email Address:

Genetic Counselor CEUs: This event has been submitted to the National Society of Genetic Counselors (NSGC) for approval

of Category 1 CEUs. The American Board of Genetic Counseling (ABGC) accepts CEUs approved by NSGC for purposes of

recertification. Approval for the requested CEUs and Contact Hours is currently pending.

CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION Genetics and Genomics Virtual Conference, May 11-12, 2016 (plus on-demand period)

Page 2: CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION …public.labroots.com/public/files/web_files/general/CEU-Certificate... · CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION Genetics

labroots

Page 2 of 3

Genetics and Genomics Virtual Conference, May 11-12, 2016 (plus on-demand period)

TIME SESSION TITLE PRESENTER(S)ELIGiBLE CONTACT HOURS

CONTACT HOURSEARNED

Live, May 1110:30am – 11:30 am PST

Challenges and Opportunities Building IT capabilities to support Large Scale Omics Projects in a Health System

Aaron Black 1.0

Live, May 1110:30am –11:30 am PST

Whole Genome? The Future of High-Quality Genomes & Transcriptomes

Jonas Korlach 1.0

Live, May 1112:00 pm –1:00 pm PST

The FDA’s experience with emerging genomics technologies – past, present and future

Weida Tong 1.0

Live, May 1112:00 pm –1:00 pm PST

Implementing Longitudinal Clinical/Whole Genome Research

Benjamin Solomon 1.0

Live, May 111:30 pm –2:30 pm PST

Microfluidic Single Cell Exome-seq and RNA-seq analysis of Tumor Composition

Ioannis Ragoussis 1.0

Live, May 1210:30 pm –11:30 pm PST

Big data integration - Inferring and using individual patient network models

Marieke Kujjer 1.0

Genetic Counselor CEUs: This event has been submitted to the National Society of Genetic Counselors (NSGC) for approval

of Category 1 CEUs. The American Board of Genetic Counseling (ABGC) accepts CEUs approved by NSGC for purposes of

recertification. Approval for the requested CEUs and Contact Hours is currently pending.

Page 3: CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION …public.labroots.com/public/files/web_files/general/CEU-Certificate... · CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION Genetics

18340 Yorba Linda Blvd. Ste 107

PMB 427, Yorba Linda, CA 92886

T +1.714.463.4673 • F +1.714.970.2173

[email protected] • labroots.com

LabRoots Corporation © 2016

LET’S TALK SCIENCE.LET’S TALK MEDICINE.

labroots

Page 3 of 3

Total Contact Hours Earned (INSERT MAXIMUM # of ELIGIBLE CONTACT HOURS):

Total CEUs Earned (10 hours = 1 Category 1 CEU):

Signature of Attendee:

TOTAL AMOUNT DUE PER ATTENDEE: $25

☐ Visa ☐ Mastercard ☐ American Express ☐ Discover

Name on card:

Credit card number:

Exp. Date:

Scan and Email to: [email protected], or Fax to: +1.714.463.4673

CVC Code:

Genetic Counselor CEUs: This event has been submitted to the National Society of Genetic Counselors (NSGC) for approval

of Category 1 CEUs. The American Board of Genetic Counseling (ABGC) accepts CEUs approved by NSGC for purposes of

recertification. Approval for the requested CEUs and Contact Hours is currently pending.

CEU SELF REPORT SHEET & CERTIFICATE OF COMPLETION Genetics and Genomics Virtual Conference, May 11-12, 2016 (plus on-demand period)