Please Indicate Submission Type(Required)Activity Review $75.00 + taxActivity Reaccreditation $75.00 + taxActivity FAST TRACK Review $200.00 + taxActivity RUSH Review $500.00 + taxNote: Taxes not includedIf submitting a Reaccreditation, please provide the NACOR Course #Host/Affiliated Company/SponsorExact title of submissionName and title of speaker(s)Please enclose a speaker bio or CV specifying professional designation, education and affiliationMax. file size: 128 MB.Type of activity. Please list all that apply. Live presentation Webinar Distance learning Scholastic Length of time of actual presentation or word count if applicable(Required)Presentation Date(s) if applicableLocation(s) of presentationIs this submission available to all Opticians?Not applicable if submitting for presentation in British Columbia Yes No List of the National Continuing Competencies covered within this submission.(Required)Can be submitted within an accompanying document. Learning outcomes. Can be submitted within an accompanying document.Specific skills, activities or items of information which course attendees will be expected to incorporate into their professional dutiesLevel of knowledge and skill required for best benefits to participantsi.e. entry-level / intermediate / advancedA copy of the presentation, the quiz (if applicable) & any handouts, etc. must be included with your applicationMax. file size: 128 MB.Billing InformationName of person submitting application(Required) First Last Company Name(Required)Job TitlePhoneEmail(Required) Billing Country(Required)Select CountryCanadaUnited StatesCanadian Billing Address(Required) Suite/Apt & Street Address OR PO Box Number City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code United States Billing Address(Required) Suite/Apt & Street Address OR PO Box Number City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Accreditation FeesBritish Columbia Tax Price: $ 0.00 CAD Alberta Tax Price: $ 0.00 CAD Manitoba Tax Price: $ 0.00 CAD Saskatchewan Tax Price: $ 0.00 CAD Nova Scotia Tax Price: $ 0.00 CAD Newfoundland & Labrador Tax Price: $ 0.00 CAD New Brunswick Tax Price: $ 0.00 CAD Nunavut Tax Price: $ 0.00 CAD Northwest Territories Tax Price: $ 0.00 CAD Yukon Tax Price: $ 0.00 CAD PEI Tax Price: $ 0.00 CAD Quebec Tax Price: $ 0.00 CAD Ontario Tax Price: $ 0.00 CAD TotalForm Total Credit Card(Required) MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name All applications can be submitted to the NACOR office via mail, email or fax. CLICK HERE to download the Continuing Education Activity Accreditation Application Form.
