AzSRC CE Certificate This is the form for learners or attendees to submit their information & fill out the survey to have their certificate automatically generated. Step 1 of 2 50% Contact DetailsName(Required) First Last Email(Required) Enter Email Confirm Email PhoneName of your current employer?(Required) Please fill out this post-course evaluationPlease rate the teaching effectiveness of the presenter.(Required)1 – Poor2 – Fair3 – Good4 – Excellent5 – SuperiorOrganizationDeliveryContentAudio VisualWere the educational objectives met?(Required)Strongly AgreeAgreeDisagreeStrongly DisagreeThe content of this session was presented without bias of any commercial product or drug.(Required)Strongly AgreeAgreeDisagreeStrongly DisagreeComments (optional)Please provide additional comments or suggestions on this session and presenter. If you believe this session was presented with commercial bias, please explain.Was this course in person or virtual?(Required)In PersonVirtualAre you AARC/AZSRC member?(Required) Yes No AARC/AZSRC Membership Number(Required)Credential(s)(Required)Enter your respiratory care credential(s) as they should appear on your certificate.State License #Optional — enter your state respiratory care license number if applicable.
