CE Credit Purchase | Arizona Society for Respiratory Care

Hospital / Facility*

Primary Contact*

First Last

Phone*

Email*

CE Certificates will be confimred with this email address.

Organization Address*

The mailing address for the organization or individual purchasing these credits. This is the only address we collect — you will not be asked for it again on the CE Credits Application.

Street Address Address Line 2 City State ZIP Code

CEU Application Credits*

Select the amount of application credits based on your predicted number of continuing education applications that you will use this calendar year. Each date will count as an application. Any unused credits are NOT transferable to the next year.

Total

Payment Method*

Payment must be received prior to program approval. Make checks payable to:

Arizona Society for Respiratory Care

Mail to:
1959 S. Power Rd.
Suite 103-292
Mesa, AZ 85206

Credit Card*

Card Details

Cardholder Name

Spam Check: What goes up, must come ____.*

Please complete the phrase in order to submit your request.