Distance Learning Registration Form 25-26

FEE: $285.00 per connection (Site or Teacher)

** PRE_THANKSGIVING SPECIAL** All programs completed before Thanksgiving will receive a discounted price of $205.00

VIDEO-CONFERENCING OPTIONS:

If students are in the classroom or school building we can connect via Zoom. If students are doing e-learning at home we can connect via Zoom, which AIMS can set up, or Google Meets if teacher/school can set up connection.

TIME:

Please note that all programs are scheduled in Central Standard Time (CST).

CONFIRMATION:

Effects of Drugs and Alcohol

Anatomy of the Eye/Pig Eye Dissection

Anatomy of the Human Heart

Anatomy of the Human Brain

Pig Heart Dissection

Sheep Brain Dissection

General Cadaver Demonstration ** Intended for anatomy based classes**

Forensic Autopsy Cadaver Demonstration- ** Intended for forensics/criminal justice classes only**

Sports Medicine Cadaver Demonstration

** If requesting multiple programs, please submit multiple registration forms.**

Please note that if you have more than one site, please reach out to laura.jenkins.1@health.slu.edu for further direction.

By submitting this registration, I understand that the AIMS Virtual Anatomy Classroom programs are designed for live delivery via teleconference and I affirm that NO recording will be made of any AIMS Virtual Anatomy Classroom distance learning program. Recording of a cadaver is against Missouri State Law and your program will be banned from any further participating from any SLU programs going forward.

School/Program Name*

School/Program City*

School/Program State*

Requestor's Name*

Requestor's Email Address*

example@example.com

Requestor's Phone Number*

Please enter a valid phone number.

Billing Contact Name:

Billing Contact Email Address:

example@example.com

Billing Contact Phone Number:

Please enter a valid phone number.

Teacher's Name (This may be the same as the Requestor)*

Teacher's Email (This may be the same as the Requestor)*

example@example.com

Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Teacher's Phone Number*

Preferred Program Date*

Date

2nd Preferred Date*

Date

3rd Preferred Date*

Date

Program Topic*

Program Start Time (CENTRAL STANDARD TIME, CST) Example: 8:30 am CST, All programs are taught in real-time, they are not prerecorded. *

Video Conference Connection:*

Students will be in one location at schoolStudents will be at home, AIMS will set up Zoom connectionStudents will be at home, teacher/school will set up Google Meets connectionUncertain at this time

Student Grade Level (Choose all that apply)*

Cancellation Policy – AIMS will not charge for programs canceled due to weather-related issues, such as snow days, power outages, or natural disasters. The full program fee will be charged if no notice or communication is received at least 48 hours prior to the scheduled program date. If notice of cancellation is received within the 48-hour window, the site will be given the opportunity to reschedule their program at no additional cost.*

I acknowledge that I have read the AIMS cancellation policy and agree to its term.

Where did you hear about the AIMS program from?*

If you answered other, please share with us where you found us at!

Additional Comments