Old Certificate Request Form Full Name Question Title * 1. Full Name OK Current Email Address Question Title * 2. Current Email Address OK Conference/Activity Title Question Title * 3. Conference/Activity Title OK Organizer or Sponsor of Conference/Activity Question Title * 4. Organizer or Sponsor of Conference/Activity OK Year of Conference/Activity Question Title * 5. Year of Conference/Activity OK Type of CEU (if you are unsure: http://www.nsgc.org/page/ceuapproval) Question Title * 6. Type of CEU (if you are unsure: http://www.nsgc.org/page/ceuapproval) Category 1 Category 2 OK Additional Information (if your certificate is under an alternate name or email address, etc.) Question Title * 7. Additional Information (if your certificate is under an alternate name or email address, etc.) OK DONE