ceu self report sheet & certificate of completion...
TRANSCRIPT
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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)
labroots
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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.
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T +1.714.463.4673 • F +1.714.970.2173
[email protected] • labroots.com
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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)