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- Strategic Plan
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WV AMP
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- 2026 WVRHA Conference
WV Health Jobs
Leadership Program

About
- Board of Directors
- Strategic Plan
Resources
WV AMP
News
Events
Get Involved
Conferences
- 2026 WVRHA Conference
WV Health Jobs
Leadership Program

Fall 2025
Conference Registration
for Speakers

Name *

First

Last

Title *

Name you would like to appear on your name tag, if different than above.

Email *

Email

Confirm Email

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone *

Your mobile phone number will not be shared. It is used for the conference application verification only.

Company/Employer Name *

Work Phone

Work/Practice Location(s) Address *

Address Line 1

Address Line 2

City

State

Zip Code

Work/Practice Location(s) County *

Number of years/months worked at this site:

Do you currently serve as a preceptor for students?

Name of health professional school attended, if applicable

Year of Graduation

As a student, did you participate in a rural or community rotation?

Do you have any dietary restrictions? *

Yes
No

If yes, please list dietary restrictions.

Are you currently a student? *

Yes
No

Do you want your contact information to be available to sponsors? *

Yes
No

Are you interested in claiming CEU credit? *

Yes
No

WVRHA has applied for CEU credits for the fields listed below. Please check the box beside your field.

Physician
Physician Assistant
Nurse Practitioner
Nurse
Pharmacy
Psychology
Social Work

Health Profession/Worker Discipline (if your chosen professions ask to specify specialty/discipline, please do so in the following question)

Advanced Practice Registered Nurse (specify)
Allied Health
Caregiver
Case Manager
Chiropractor
Clinical Nurse Specialist (specify)
Community Health Worker
Counseling
Dental Assistant
Dental Hygienist
Dentist
Dentist, Oral Surgery
Dentist, Pediatric Dentistry
Dentist, Endodontics
Dentist, Orthodontics
Dentist, Prosthodontics
Dentist, Pathology
Dentist, Radiology
Health Education
Dietitian/Nutritionist
First Responder
Health Information Technology/Health Informatics
Home Health Aide
Marriage and Family Therapy
Medical Assistant
Medical Interpreter
Nurses (Licensed/Practical)
Nurse (Registered)
Nursing, Other (please specify)
Nutritionist
Occupational Therapist
Optometrists
Pastoral/Spiritual Care
Pharmacist
Physical Therapist
Physical Therapist Assistant
Physician (please add specialty)
Physician Assistant
Podiatrist
Psychologist, Clinical
Psychologist (specify)
Public Health - Biostatistician
Public Health - Disease Prevention & Health Promotion
Public Health - Environmental Health
Public Health - Epidemiology
Public Health - Health Policy & Management
Public Health - Infectious Disease Control
Public Health - Injury Prevention
Public Health - Social & Behavioral Sciences
Recreational Therapy
Respiratory Therapist
Retired and/or Unemployed
Social Work, Clinical
Social Work (specify)
Speech Therapy
Student
Substance Abuse/Addictions Counseling
Veterinarian
Other, not listed (specify below)

Specialty/Discipline (if applicable)

Do you plan to apply this training toward your employment requirements, continuing education credit, certification, or credentialing?

Our mission is to unite people, communities and organizations to strengthen rural health in West Virginia.

P.O. Box 908
Barboursville, WV 25504
304-435-7491

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Fall 2025Conference Registration for Speakers

Fall 2025
Conference Registration
for Speakers