FEES to receive videos (fee includes return shipping and handling, CE Credit, and processing)
$11.00 for one title
$2.00  for each additional title‚
NO CHARGE if you pick up video from Upstate AHEC office.

• You may keep a video four weeks. A late fee of $5.00 per week will be applied to material kept longer than the allotted time.
• If books/videos are lost, damaged, or stolen while in your possession, you will be financially responsible for replacing these materials.
• Video rentals are available only to locations within the Upstate AHEC 11 county region.

CREDIT: Each participant will receive a certificate of completion and one contact hour of continuing education.

You may also print this form out and send it to us with your check to:
Upstate AHEC – 200 N. Main Street, Suite 201 – Greenville, SC 29601
Fax: 864-349-1179 – 24 hours a day
e-mail: aross@upstateahec.org

.

* Required Field

Name *

credentials

Permanent Address ^*

City ^*

Select a State ^* Choose State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip ^*

Home Phone *

Work Phone

Email ^*

Video Selections:

• 701 How To Care For Someone On Bedrest
• 702 Como atender a quien guarda reposo en cam
• 703 How To Help Someone Who Uses A Wheelchair Without Hurting Yourself
• 704 Como ayudar a una persona en silla de ruedas sin lastimarse a si mismo
• 705 Creating Healthy Home Care Conditions: Infection Control
• 706 Lucha contra la infeccion
• 707 How To Manage Medications
• 708 Los medicamentos
• 709 Fall Prevention
• 710 Evitar Caidas
• 711 Fire Safety
• 712 La prevencion de incendios
• 713 Elder Abuse and Neglect
• 714 Personal Care
• 715 El Cuidado Personal
• 716 Caregiver Wellness
• 717 How to Measure Vital Signs
• 718 How To Communicate Effectively With Someone Who Has Hearing Loss
• 719 How To Communicate With Someone Who Has Aphasia
• 720 How To Communicate With Someone Who Has Alzheimer's Disease
• 721 Como comunicarse con alguien que padece de Alzheimer's
• 722 Developing Cultural Competence
• 723 Caring For Someone With Mid To Late Stage Alzheimer's Disease: 43 minutes

Terms & Conditions

please accept the terms

• I understand that by completing this request form, I am agreeing to be financially responsible for any materials that are lost, stolen or damaged while in my possession.
• I will pick up videos from Upstate AHEC office.
• I would like the videos mailed to my address above and will pay online.
• I would like the videos mailed to my address above and will mail a check.

* Required Field