Sleep Professionals of Arkansas

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2025 W9

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Registration
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Name *

First Name

Last Name

Email Address *

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Professional Credentials *

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Member Number (optional)

Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

One Day Registration

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

opt-in to communication with exhibitors *

Yes

Multiple Attendee information

One Payment

please check here if you plan on paying for several attendees.

Multiple Attendees

Attendee 2

First Name

Last Name

Attendee 2 Email

Attendee 2 Phone

(###)

###

####

Attendee 2 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 2 Member Number (optional)

Attendee 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 2 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 2 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 2 opt-in to communication with exhibitors

Yes

Attendee 3

First Name

Last Name

Attendee 3 Email

Attendee 3 Phone

(###)

###

####

Attendee 3 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 3 Member Number (optional)

Attendee 3 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 3 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 3 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 3 opt-in to communication with exhibitors

Yes

Attendee 4

First Name

Last Name

Attendee 4 Email

Attendee 4 Phone

(###)

###

####

Atendee 4 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 4 Member Number (optional)

Attendee 4 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 4 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 4 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 4 opt-in to communication with exhibitors

Yes

Attendee 5

First Name

Last Name

Attendee 5 Email

Attendee 5 Phone

(###)

###

####

Atendee 5 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 5 Member Number (optional)

Attendee 5 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 5 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 5 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 5 opt-in to communication with exhibitors

Yes

Attendee 6

First Name

Last Name

Attendee 6 Email

Attendee 6 Phone

(###)

###

####

Attendee 6 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 6 Member Number (optional)

Attendee 6 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 6 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 6 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 6 opt-in to communication with exhibitors

Yes

Attendee 7

First Name

Last Name

Attendee 7 Email

Attendee 7 Phone

(###)

###

####

Attendee 7 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 7 Member Number (optional)

Attendee 7 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 7 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 7 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 7 opt-in to communication with exhibitors

Yes

Attendee 8

First Name

Last Name

Attendee 8 Email

Attendee 8 Phone

(###)

###

####

Attendee 8 Professional Credentials

Check all that apply

DDS

Nurse

Pharm

Sleep Tech

EEG Tech

None

Attendee 8 Member Number (optional)

Attendee 8 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Attendee 8 Registration

INCLUDES SPA MEMBERSHIP THROUGH DECEMBER 31, 2025

Doctoral $310

APRN $310

Technologist, Professional, Affiliate $200

Student $55

none

Attendee 8 One Day

Does not include SPA Membership, Check day attending

Doctoral, Friday $185

Doctoral, Saturday $185

APRN, Friday $185

APRN, Saturday $185

Technologist, Professional, Affiliate, Friday $120

Technologist, Professional, Affiliate, Saturday $120

none

Attendee 8 opt-in to communication with exhibitors

Yes

Thank you for Registering for Arkansas Sleep 2024

MAIL PAYMENT TO:
(please include registered name on memo line)

Sleep Professionals of Arkansas
188 Jones Road
Nashville, Arkansas 71852

For Questions or Further information call: Charli Evans, RPSGT, RST Phone (479)-463-2784 Email charris@wregional.com

No refunds after February 17th, 2025. A $50 administrative fee will be assessed for all refunds.
ONSITE REGISTRATION MUST BE PAID BY CASH OR CHECK

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The American Academy of Sleep Medicine and the Sleep Professionals of Arkansas and Washington Regional Center for Sleep Disorders. The American Academy of Sleep Medicine is accredited by the ACCME to provide continuing medical education for physicians.

AASM designates this live activity for AMA PRA Category 1 Credits™:

Arkansas Sleep 2025- Maximum of 12.00

AASM Continuing Education Credits (CECs) for sleep technologists are offered for this live activity. AASM designates this live activity for AASM CECs:

Arkansas Sleep 2025- Maximum of 12.00

The AASM will issue all other non-physicians a letter of attendance for activities designated for AMA PRA Category 1 Credits™.

Physicians and all other participants should claim only the credit commensurate with the extent of their participation in the activity.

Target audience: Physicians, Phys. Assistants, Dentists, Nurses, Nurse Practitioners, Respiratory Therapists, Sleep Technologists, and other professionals interested in sleep medicine.

Overall course learning objectives:

Develop the awareness and value of skills and services members of the many professional disciplines provide related to the practice of sleep medicine in Arkansas for the purpose of improving care delivered by the learner.
Discuss how multidimensional sleep health relates to other physical and mental health outcomes.
Bringing the providers of sleep medicine services into a common learning environment to promote cooperation, enhanced knowledge of best practices, and networking.

Your CRCE application for Arkansas Sleep 2025 has been approved.

Applicant Name: Washington Regional Center for Sleep Disorders & Sleep Professionals of Arkansas

Title of Activity: Arkansas Sleep 2025

Course Number: 193856000

Peer Review Action: Approved

Approved Contact Hours: 12.00

Planner Disclosures:
The following planners have no relevant financial relationships with any ineligible companies to disclose:

Charli Evans, RST, RPSGT
Caris Fitzgerald, MD
Michele Blocker, RPSGT, RST
David Davila, MD
Alyssa Ebersole (AASM)