continuing education NAMSS CE Quiz: Leadership Skills: Professional Ethics Instructions: Make a photocopy of this form – DO NOT REMOVE THE PAGE from the magazine so that others also may use it to obtain CE credit. Print your name and address in the form below. This form will be mailed back to you to use as your CE credit certificate. DEADLINE TO SUBMIT YOUR QUIZ FOR CREDIT IS DECEMBER 20, 2013. Take this quiz online and receive your results immediately! Click the SYNERGY Quizzes link in the Headlines section of www.namss.org. Name: Facility: Address: City/State/ZIP: Title: Business Phone: Signature: Date: Answers Place an “X” in the box next to the correct answer. True/False and Multiple Choice 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. a. ❑ a. ❑ a. ❑ a. ❑ a. ❑ a. ❑ a. ❑ a. ❑ a. ❑ a. ❑ b. ❑ b. ❑ b. ❑ b. ❑ b. ❑ b. ❑ b. ❑ b. ❑ b. ❑ b. ❑ c. ❑ c. ❑ c. ❑ c. ❑ c. ❑ c. ❑ c. ❑ Payment Information ❑ Processing Fee: $15 members OR $25 non-members ❑ Check Payment: Enclosed is a check or money order payable to NAMSS (DO NOT SEND CASH). Check No.: Date: Amount: $ Check one: ❑ Facility Check ❑ Personal Check ❑ AMEX ❑ Discover ❑ Credit Card Payment: Check one: ❑ MC ❑ Visa I authorize NAMSS to charge my credit card $ Credit Card No.: Exp. Date: Cardholder’s Name (PLEASE PRINT): Facility (IF APPLICABLE): Cardholder’s Address: City/State/ZIP: For NAMSS Executive Office Use Only Score: ❑ You have passed this quiz and earned one (1) Category I CE clock hour. ❑ You scored below 80% and DO NOT earn CE credit. NOTE: No record will be kept at NAMSS of this quiz. Keep this form as evidence of completion. Cardholder’s Phone: Authorized Signature: I understand my billing statement will read “NAMSS.” If rebilling a credit card is necessary, a $25 processing fee will be charged. A charge of $25 will apply for all non-sufficient fund checks. Mail To: NAMSS Attention CE Department 2025 M Street, NW, #800 Washington, DC 20036 30 / SYNERGY NOVEMBER/DECEMBER 2012http://www.namss.org/MemberCenter/NAMSSStore/tabid/70/keyword/synergy/Default.aspx