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CPE Credit - Area Workshop
This form is for offering a workshop for CPE credit at an area workshop.
* Required
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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MM
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DD
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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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MM
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DD
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YYYY
Time of Presentation
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Time
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AM
PM
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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