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Continuing Education Activity Plan Sponsor Form

"*" indicates required fields

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It is recommended, but not required that this activity form be submitted at least 30 days prior to the start of the activity.

Activity Number - Please leave blank as these will be assigned to you after registration
Location of Activity*
MM slash DD slash YYYY
MM slash DD slash YYYY
Start Time for Activity (EST)*
:
Ending Time for Activity (EST)*
:
Content Area*
Content Level*
Participating Programs*
Is this workshop closed to the public?
Choose your payment option*