ࡱ > w y v Y K bjbjdd 7* b b X X 8 $ D D k $ Y # 4 % J J J R J J J J IZ R R J ; 0 k J # # J # J Z @ J V 4 v k # X B : Date of Webinar: _____________________________________________________________________________ Primary Registrant: ___________________________________________________________________________ Attended at: _________________________________________________________________________________ PRINT NAME & SignatureMailing AddressE-Mail Address & Telephone NumberSECONDARY/CE REGISTRANT: I verify that the above noted individuals did attend the webinar at the site indicated. _________________________________________________________________________________________________ Registrant Signature Print Name Date **NAMSS CE credits A NAMSS CE certificate will be provided to the person who registered for the webinar. For others present at the webinar, please complete the form above and include $10.00 for each person requesting a CE certificate. Additional copies of the form are acceptable. Contact education@namss.org with questions. Submit to the NAMSS office with a $10.00 fee for each CE certificate requested. NAMSS 2025 M Street, NW Suite 800 Washington, DC 20036 Payment Method: ( Check Payment* Check Number ___________________ Check Amount $ _________ Date ______ Check Type ( Facility OR ( Personal ( Credit Card Payment** ( VISA ( MasterCard ( American Express ( Discover Total Amount to Charge $ ______ Account Number Expiration Date ___________ Cardholders Name Phone ________________ Signature ______________________ *A $25 charge will apply for all non-sufficient fund checks. **I authorize NAMSS to charge my credit card in the amount indicated above. I understand that NAMSS reserves the right to charge the correct amount if totaled incorrectly. I understand that my billing statement will read NAMSS, and that if rebilling a credit card is necessary, I will be charged a $25 processing fee. Sharing Peer Review Information Among Entities: Why, When, and HowMarch, 2017 CE SIGN-IN SHEET E ^ # ' @ A X _ ɲ{oc[QGQ h)/ OJ QJ ^J h= OJ QJ ^J hE hU 5hE hU 5OJ QJ hE h/7K 5OJ QJ hp 5OJ QJ hE ha. 5OJ QJ hE hY G 5OJ QJ h h OJ QJ h h* OJ QJ h h/7K OJ QJ h h/7K 5OJ QJ h h* 5OJ QJ h* h/7K 5OJ QJ h 5OJ QJ h* h* 5OJ QJ h* 5OJ QJ A N X ` h y $$If a$gdE d d [$\$gd _ V J J J J J $$If a$gdE $If gda. kd $$If l 4 F !3 : u t 0 6 4 4 l ap ytE _ S S S S S S S $$If a$gdE kd $$If l 4 F !3 : u t 0 6 4 4 l ap ytE _ S S S S S S $$If a$gdE kdt $$If l 4 F !3 : u t 0 6 4 4 l ap ytE _ S S S S S S $$If a$gdE kd. $$If l 4 F !3 : u t 0 6 4 4 l ap ytE _ Z Z Z Z Z Z Z U gd5 gd kd $$If l 4 F !3 : u t 0 6 4 4 l ap ytE E \ ] t | 4 M N S T e f ̱̱wh h h CJ OJ QJ aJ hj7 h W OJ QJ hU OJ QJ h W OJ QJ hj7 hj7 OJ QJ h5 hz 5OJ QJ hz OJ QJ hUL OJ QJ hj7 OJ QJ hj7 hU OJ QJ hj7 ha. OJ QJ h)/ OJ QJ h5 h OJ QJ ^J h/7K h h/7K h OJ QJ ^J % N T f p . " # ` gd ( gd ( ( gd x x `gd x x gd gdY G gdU / 0 7 8 E F Y Z ~ ! " ηηηΫ j h1H Uhsz h'6 j h'6 Uh hz OJ QJ h h 6OJ QJ h >*OJ QJ j qh h OJ QJ h h >*OJ QJ h h OJ QJ j oh h OJ QJ h h 5OJ QJ 4 ? @ A B C D E F G H I J K gd $a$gd* $0^0a$gd{g - . ? A B C D E F G H J K ˾ h hz OJ QJ h'6 hsz h5 hH hFK 5CJ OJ QJ aJ hH h5 5CJ OJ QJ aJ hjy 5CJ OJ QJ aJ hsz 5CJ OJ QJ aJ hH hH 5CJ OJ QJ aJ hsz hsz 5CJ OJ QJ aJ ht hH 5 1F0:p = /!"#$% $$If !v h#v #v#v:V l 4 t 0 65 :55uap ytE $$If !v h#v #v#v:V l 4 t 0 65 :55uap ytE $$If !v h#v #v#v:V l 4 t 0 65 :55uap ytE $$If !v h#v #v#v:V l 4 t 0 65 :55uap ytE $$If !v h#v #v#v:V l 4 t 0 65 :55uap ytE v D d L d C 2 A d b l _ b a r _ l o g o " ` b v oT?4e̘b u nu oT?4e̘bPNG IHDR `PLTE lu ~0@P`ʯٿp j tRNS } bKGD H cmPPJCmp0712 H s tIDATx^]b(mҬ"@aKnԗ ? vsAA@QBaGA@A@(E@bR9A@.K2ZA@(E@ر)yNaҷVJv,EJB"? ǎpdF# `vCAC@QBaGA@Jر)yNaҷVJv,EJB@-RKAv.}hAaR9A@.K2ZA@(E@ر)yNaҷVJv,EJB@-RKAv.}hAu~/^뀀 9NG!)R~`~&pw/mɒ%O>f?/Goׇ㐷.oOEu0{<tq8B9{і5Uo?>lr>Su4K;Tl`~V??xO$Gt_6m?'