2019 CHMS CE Form

2019 CHMS Conference

Continuing Education Form

Documenting ACHENA-approved Homeopathic Education Hours and CEUs for Registered Nurses and Chiropractors
California BRN Provider # CEP 12989

Please complete this form to document your conference participation hours. There is no charge for the letter of documentation for ACHENA Homeopathic Education Hours.

If you would like an official certificate for CEUs (RN, Chiropractor) please select "CE Certificate (Pay with PayPal)" at the end of the last page and complete your payment using the PayPal system. The fee for each NON-ACHENA CEU certificate is $35.

All others will receive an ACHENA letter upon completion of this evaluation form at no charge.

Please allow 2-3 weeks for processing. Your letter or certificate will be delivered by email in PDF format.
Your Name *

First Name Last Name
Your E-mail address *
Your Certificate will be delivered by email in PDF format.
Retype E-mail address *
Please make sure your email address is correct before proceeding.
NAME & CREDENTIALS *
Please type your name and credentials EXACTLY as you would like them to appear on your letter/certificate.
Your Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

PART 2: SUBMIT FORM AND COMPLETE PAYMENT

Upon completion of this form you will either receive (pdf format, via email) either:

1) FREE. A letter documenting your ACHENA-approved Homeopathic Education Hours, or;

2) $35. A CEU certificate including the CHMS CE provider number (for RNs, etc.)

There is no charge for the ACHENA letter; each CEU Certificate requires a $35 payment.

If you paid in advance for your CEU certificate, please select the option below for the PREPAID CE Certificate. If you have NOT paid already, please use the 'Pay with PayPal' option below. (Note: if you do not have a PayPal account, please choose 'Pay with Debit or Credit Card' at the PayPal checkout & you may use any card.)

Please allow 2-3 weeks for processing. Your letter or certificate will be delivered by email in PDF format.
For 2020 please update to automatically charge $20 after specified date for the ACHENA letter
Choose One
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Letter of Documentation (ACHENA) Free

CE Certificate (Pay with PayPal) $ 35.00

CE Certificate (prepaid) Free
Should be Empty:

	Absolutely Yes	Yes	No	Absolutely No	No Opinion
Was attending the program a good use of your time?
Did the program contribute to your professional effectiveness and improve your ability to treat and manage clients/patients?
Did the program address a professional practice gap?
Will you be able to apply what you learned in your practice?
Was the length of the program appropriate for covering the intended material?

	Absolutely Yes	Yes	No	Absolutely No	No Opinion
Present current information and seem knowledgeable about the topic?
Have the ability to communicate clearly?
Relate the content of the presentation to clinical practice?
Respond appropriately to questions and comments?
Did the presenter’s visual aids and handouts contribute to your learning?

	Absolutely Yes	Yes	No	Absolutely No	No Opinion
Was attending the program a good use of your time?
Did the program contribute to your professional effectiveness and improve your ability to treat and manage clients/patients?
Did the program address a professional practice gap?
Will you be able to apply what you learned in your practice?
Was the length of the program appropriate for covering the intended material?

Sunday, May 19th