This is how to request a CE certificate for each presentation you attended.

• You must complete and submit this form for EACH presentation you attended.
• You must complete the evaluation questionnaire ONCE.
The deadline for submitting these requests is Monday July 18.

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* 1. Name and Contact information

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* 2. Degree/License Type

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* 3. State(s) or Province(s) of License

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* 4. License number(s) for each state/province listed above

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* 5. Presentation attended (select only one - you must submit a separate survey for each presentation attended)

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