UK Ampcare ESP Registration Processed through Medicare Innovations International, Ltd. UK Ampcare CE Registration FormFirst Name *Last Name *Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryCredentials for Certificate *Speech and Language TherapistMRCSLTM.A. - SLTM.S. - SLTPh.D. - SLTOtherList here if Other Phone *Email *Training Options *If you select a Hybrid Zoom Webinar or Live option, please choose your training date.Online Self-Directed CE Training (8 hours)Hybrid Zoom Webinar CE Training (4-hours Online/4-hours Webinar)Live, In-Person Blended CE Training (10 hours)Hybrid: On-Demand + Zoom Webinar Hybrid: Completion of the 4 hours of pre-work required.September 18-19, 2024: 2 - 4 PM BST each dayMarch, 2025: TBCLive/In-Person Blended course; 4-hours online, 6-hours in-personDates in 2024: TBDDates in 2025: TBDI have a group and would like to discuss scheduling a Live courseAffiliation *Trust, Company, or Facility NameAdditional Comments Will you need ASHA CE Hours You are an International Member of the American Speech & Hearing Association and you will submit these CE Hours for renewal.YesNoList ASHA Number here if applicable: VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
