Media Request

Media Request Form

Use this form to send information to the Engagement Team for publication to our Website, Facebook pages and communication to members via Mail Chimp.

Registrations will be sent to atlanticprovincesaba@gmail.com

Event General Information

* Indicates required field

Title of Event *

Date and Time of the Event *

Name of Presenters (and their credentials) *

Upload a photo of the presenters *

Max file size: 20MB

Additonal Photo (If applicable) *

Max file size: 20MB

CEU Information

How many CEUs are available? *

How many of the CEUs are Ethics CEUs? *

How many of the CEUs are Supervision CEUs? *

Member cost - No CEUs *

Member Cost - With CEUs *

Non-Member Cost - No CEUs *

Non-Member Cost - With CEUs *

Event Details

Summary of Event *

Learning Objectives *

Upload a Summary of the Event and Learning Objectives *

Max file size: 20MB

All event registrations will require the following information from the registrant: name, email, certification number. If you require additional information please include below.

Additional Information *

Request Submitted by:

Name *

First

Last

Email *

All requests will be reviewed by the Engagement Team. If information is missing, or clarification is needed, we will be in touch with the person making the request.

Forms will be available on the website within 5 business days of receiving the completed form.

All event registrations will close 5 days before the event.

Once the registration is open, promotion of the event will also be put on our Facebook page (both public and members only), and distributed via MailChimp. Any changes to this will be at the discretion of the Engagement team.

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