Request for Course Credit for Participants Attending as a Group

Request for Course Credit for Participants Attending as a Group

This field is for validation purposes and should be left unchanged.
Name of Person whose Zoom Registration was used to attend (This should be the account used to log in to the webinar for verification purposes)(Required)
For each additional person attending with you please complete all fields. Failure to do so could delay the receipt of course credit.
Name
Mailing Address
Phone Number
Email
Association
Role
 
I certify that the following persons attended the entirety of the webinar presentation.

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