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CPE Credit - Area Workshop
This form is for offering a workshop for CPE credit at an area workshop.
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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YYYY
Time of Presentation *
Time
:
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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