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* 1. Name of Instructor including credentials

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* 2. Date

Date / Time

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* 3. Email Adress

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* 4. Phone Number (s)

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* 5. Name of Course

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* 6. Number of CEUs offered and organization that is offering them

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* 7. Brief description of the course (150 words maximum)

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* 8. Brief autobiographical statement (50 words maximum)

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* 9. Website or email where potential students can access more information about the course and receive instructions for processing a course fee.

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* 10. Please upload an image that represents your course that we can use to advertise it. 

JPEG, JPG file types only.
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