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CPE Credit - Area Workshop
This form is for offering a workshop for CPE credit at an area workshop.
Area *
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Area Coordinator *
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Area Coordinator’s Email *
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Date of Application *
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YYYY
Contact Name *
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Email *
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Phone (xxx-xxx-xxxx) *
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Street Address or P.O. Box *
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City
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State *
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Zip Code *
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Date of Presentation *
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DD
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YYYY
Time of Presentation *
Time
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Location of Presentation *
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Title of Presentation *
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Brief Description of Presentation *
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Name of Presenter *
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Presenter’s Credentials *
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Name of Additional Presenter (if more than 1 presenter)
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Additional Presenter’s Credentials (if applicable)
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Length of Presentation *
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Number of CPE Hours Requested *
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