ADEA/AAL IAHE
Online Registration

Advances in Educational Methods for Allied Health Educators

Fields denoted with a red asterisk (*) are required.

You MUST complete this registration form and click the Submit Registration button even if you are sponsored by your institution or a scholarship. Only by submitting this form can you ensure that AAL will hold a spot for you in this program.


Your email address will be used as your Username to login after your account is created.

Email *
Confirm Email *
Password *

First Name *
Last Name *
Suffix
Preferred Name
Designation *
School/Institution Affiliation (if none, enter N/A) *
Academic Rank *
Discipline/Specialty *
Job Title/Position *
Academic Appointment
Number of years as full-time faculty (if applicable)
Gender *


Race/Ethnicity: * (check all that apply)







*If selected other, please specify
Age (select range:) *





Address Type (select the type of address you are providing in the following lines to receive print communication, including program certificate, from AAL) *

Street Address *
City *
State *
Country *
Zip/Postal Code *
Work Phone (xxx-xxx-xxx) *
Home/Cell Phone (xxx-xxx-xxx)
Fax
Emergency Contact Name
Emergency Contact Phone (xxx-xxx-xxx)

Please indicate the highest degree(s) you have earned: * (check all that apply)
















*If selected other, please specify
If CE credits are available for participating in this program, please indicate if you want to earn the CEUs (a "NO" answer indicates that you will only audit the program and not complete the assignments to earn the CEUs) *
How did you learn about this program?
*Please Specify
If you have attended any AAL or AAL-affiliated program previously, please check all that applies and specify the year that you attended. Please also include any future program that you are already registered for (check all that apply).

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance

Year of Attendance
Please select your method of payment *



Scholarship
Invoice Information
If paying by personal check or institution sponsor, please provide the contact and address information here to be invoiced. If paying by scholarship, please indicate the name of the organization providing it. If paying by credit card, you will be taken to the online payment system after submitting this registration. If requesting an AAL-approved payment plan, please indicate the duration.

Terms and Conditions of Registration *
I understand that by registering to participate in this program, I am required to attend all activities and complete all assignments throughout the program. I understand that, once I receive acknowledgement of my registration from AAL, the tuition fee is due no later than two weeks before the start of the program. Failure to submit the tuition by the deadline will result in the loss of my position in the program. After the start of any online Program, withdrawal from the online Program for any reason will result in the forfeiture of 50% of the tuition if AAL is notified within two weeks of the start of the online Program; if AAL is notified after two weeks of the start of the online Program, no refund will be given. For any onsite Program, withdrawal from the onsite Program for any reason two weeks or less before the start of the onsite Program will result in the forfeiture of 50% of the tuition; after the start of any onsite Program, withdrawal from the onsite Program for any reason will result in the forfeiture of 100% of the tuition.I understand that AAL may take photographs and video of my participation in onsite program activities. I hereby grant permission to AAL to use these photograph and video image on its World Wide Web site, on public sites such as YouTube, or in AAL printed publications without further consideration, and I acknowledge AAL's right to crop or treat the photograph and video at its discretion. I also acknowledge that AAL may choose not to use my photo and video at this time, but may do so at its own discretion at a later date. I further understand that once my image is posted on AAL's website, the image can be downloaded by any computer user on or off campus. Therefore, I agree to indemnify and hold AAL and its employees harmless from any claims. I also understand that the conduct of this program is contingent upon adequate enrollment and factors beyond the control of AAL. Should the program be cancelled for any reason, I will receive a full refund of any tuition paid to AAL. AAL is not responsible for other costs that I incur as a participant in the program. I understand that AAL is not a placement agency and makes no promise of employment as a result of participation in the program. My typed or signed name and submission of this form constitutes my Agreement to Participate.
I, Agree to the above Terms and Conditions

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