First Name in ALL CAPS (As it appears on your RUP License): *
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Last Name in ALL CAPS
(As it appears on your RUP License): *
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Company Name:
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Applicator Type: *
RUP Number *
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Sessions to Credit: For each session you attended during the December credit event, select the credit type you would like to be submitted to MDARD. Please pay attention to which credits are only offered for specific sessions.