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