Continuing Education Activity Plan Sponsor Form

It is recommended, but not required, that this activity be submitted ONLINE at myaccount.rid.org at least 30 days prior to the start of the activity. A copy of this form along with the Activity Plan Instructor’s form must be kept on file for future auditing purposes.

Name of Approved Sponsor*

Activity Number - Please leave blank as these will be assigned to you after registration

Sponsor Code

MonthYear

Ascending within Month

Activity Title*

Instructor(s) Name(s)*

Instructor Email*

Contact Person/People*

Contact Voice or Video Phone Number*

Contact Person's Email*

Website

Who is the target audience?*

Activity Start Date*

Activity Completion Date*

Total number of CEUs to be awarded to each participant*

Authorize.net Amount