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* 1. Name of Instructor(s)

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* 2. Date

Date / Time

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* 3. Email address

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* 4. Phone Number(s)

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* 5. Course Title

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* 6. CEU Credits/Hours:

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* 7. Website (if you have one)

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* 8. Organization(s) who have granted CEUs for this course

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* 9. Cost of Course to Student

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* 10. Target Audience

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* 11. General Description of Course

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