Customer Program Request Form

Customer Program Request Form

Please complete the form below so we can assist you in accessing CE courses with your SAS customer credit or if you need a brochure created for your employer to approve your CE week. Once you make your selections we will contact you by email regarding any balance that may be due. Check your spam folder if you do not receive an email within 24 hours!
Full Name

First NameLast Name
AANA Number
Number on your NBCRNA recertification card
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail address
Phone Number
Format: (000) 000-0000.
What can we help you with today?
What do you believe your conference credit value is at this time?
Not sure? No worries a SAS representative will be reaching out within 24 hours to confirm the information including your available credit balance.
Please indicate what you would like to purchase for your program. Choose all that apply as "mix and max" options are available.
You indicated you would like core modules in your program. Please indicate which programs you would like:
You selected create your own conference. Do you need a personalized brochure? Please note BROCHURES WILL NOT BE ISSUED IF requested conference start is within 48 hours of request and conference invoice is unpaid.
If you would like to redeem for a destination create your own conference please be aware that we require 5 CE per day listed on the brochure. Minimum 2 days for destination brochure. Additionally, failure to select enough courses will delay the release of your program.
Would you like the core modules as part of your brochure?
What specifics do you need listed on the brochure? dates and location for instance. Note: we will not issue brochure if conference balance is unpaid and start date is within 48 hours. BACK DATING IS NOT ACCEPTABLE.
If you would like to attend a live conference - please indicate which one. See the choices above
If you chose the Create your own conference choice, please select the courses from list below that you would like to receive. Courses are 1 Mac Ed CE unless noted otherwise. The course value is prices at $20/CE

Other
Anything additional you would like us to know? questions or clarification of above choices please make a note here for us! If you are part of a group educational program, please tell us your group name here.
Should be Empty: