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* 1. Full Name

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* 2. Current Email Address

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* 3. Conference/Activity Title

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* 4. Organizer or Sponsor of Conference/Activity

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* 5. Year of Conference/Activity

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* 6. Type of CEU (if you are unsure: http://www.nsgc.org/page/ceuapproval)

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* 7. Additional Information (if your certificate is under an alternate name or email address, etc.) 

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