Order “AFA Partners In Care” training DVD Name* First Last Email* Enter Email Confirm Email Phone*What state are you located in?*Please let us know where you are located (please use your billing address)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingProduct SelectionSocial Work Contact Hours 6 contact hours for licensed social workers AFA Partners in Care is approved for 6 Continuing Education Contact Hours for licensed social workers* Contact hours will be awarded following successful completion of the AFA Partners in Care training program and AFA Dementia Care Partner certification examination. This program is approved by the National Association of Social Workers (Approval #886446769-3742) for 6 Social Work-Pain and Symptom Management continuing education contact hours. Alzheimer’s Foundation of America, Inc. *Note: New Jersey, Idaho, and Oregon do not currently recognize NASW National Approval. Applications can be submitted to NASW State Chapters. Michigan and West Virginia do not accept National CE Approval Programs and require individual program/provider application processes. The Alzheimer’s Foundation of America, Inc. SW CPE is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #0222. DCPA Training DVD*• All fees are per person and exclusive of relevant state sales tax (Sales Tax will be added to total for NY State Purchases) • Fee includes opportunity to pursue distinction as an AFA Certified Dementia Care PartnerAFA MEMBER ORGANIZATION - (1) DCPA Training License ($165.75)NON AFA MEMBER ORGANIZATION - (1) DCPA Training License ($195.00)AFA Member Number*Additional Trainees• Please enter the additional licenses needed. Please note: Group order options include one DVD set • Fee includes opportunity to pursue distinction as AFA Certified Dementia Care Partner for (1) person. Additional certifications require fee as identified below Price: $95.00 Quantity: Additional Trainees• Please enter the additional licenses needed. Please note: Group order options include one DVD set • Fee includes opportunity to pursue distinction as AFA Certified Dementia Care Partner for (1) person. Additional certifications require fee as identified below Price: $95.00 Quantity: Are you Tax Exempt?*YesNoShipping Price: $6.80 Total Price: $0.00 School Name*Anticipated Year of Graduation*Degree/Program*Please Select OneHigh School/GEDAssociate's DegreeBachelor's DegreeGraduate-Level; Adult Learner/Continuing EducationAre you Tax Exempt?*YesNoShipping Price: $6.80 Total Price: $0.00 Are you Tax Exempt?*YesNoShipping Price: $6.80 Total Price: $0.00 Billing InformationBilling Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Type of Address*CompanyHomeCompany Name*Shipping Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe How did you hear about AFA’s training?*AFA websiteAFA mailing (Postcard or Email)AFA publication (e-newsletter or AFA Care Quarterly)AFA social servicesEmployer/colleagueFriend/family memberNewspaper/magazine/TV or radioCustomer Payment Information* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Total $0.00
Order “AFA Partners In Care” training DVD Name* First Last Email* Enter Email Confirm Email Phone*What state are you located in?*Please let us know where you are located (please use your billing address)AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingProduct SelectionSocial Work Contact Hours 6 contact hours for licensed social workers AFA Partners in Care is approved for 6 Continuing Education Contact Hours for licensed social workers* Contact hours will be awarded following successful completion of the AFA Partners in Care training program and AFA Dementia Care Partner certification examination. This program is approved by the National Association of Social Workers (Approval #886446769-3742) for 6 Social Work-Pain and Symptom Management continuing education contact hours. Alzheimer’s Foundation of America, Inc. *Note: New Jersey, Idaho, and Oregon do not currently recognize NASW National Approval. Applications can be submitted to NASW State Chapters. Michigan and West Virginia do not accept National CE Approval Programs and require individual program/provider application processes. The Alzheimer’s Foundation of America, Inc. SW CPE is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #0222. DCPA Training DVD*• All fees are per person and exclusive of relevant state sales tax (Sales Tax will be added to total for NY State Purchases) • Fee includes opportunity to pursue distinction as an AFA Certified Dementia Care PartnerAFA MEMBER ORGANIZATION - (1) DCPA Training License ($165.75)NON AFA MEMBER ORGANIZATION - (1) DCPA Training License ($195.00)AFA Member Number*Additional Trainees• Please enter the additional licenses needed. Please note: Group order options include one DVD set • Fee includes opportunity to pursue distinction as AFA Certified Dementia Care Partner for (1) person. Additional certifications require fee as identified below Price: $95.00 Quantity: Additional Trainees• Please enter the additional licenses needed. Please note: Group order options include one DVD set • Fee includes opportunity to pursue distinction as AFA Certified Dementia Care Partner for (1) person. Additional certifications require fee as identified below Price: $95.00 Quantity: Are you Tax Exempt?*YesNoShipping Price: $6.80 Total Price: $0.00 School Name*Anticipated Year of Graduation*Degree/Program*Please Select OneHigh School/GEDAssociate's DegreeBachelor's DegreeGraduate-Level; Adult Learner/Continuing EducationAre you Tax Exempt?*YesNoShipping Price: $6.80 Total Price: $0.00 Are you Tax Exempt?*YesNoShipping Price: $6.80 Total Price: $0.00 Billing InformationBilling Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Type of Address*CompanyHomeCompany Name*Shipping Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe How did you hear about AFA’s training?*AFA websiteAFA mailing (Postcard or Email)AFA publication (e-newsletter or AFA Care Quarterly)AFA social servicesEmployer/colleagueFriend/family memberNewspaper/magazine/TV or radioCustomer Payment Information* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name Total $0.00
