1. Please Enter Your Name and Contact Information: First Name: Firm/Company Name: Middle Name: Preferred Phone: 334-555-5555 Last Name: Email: Suffix:NoneIIIIIIVVCPADDSDOEdDEsqJDJrLLDMDPhDRetRNSrUSAUSAFUSAFRUSARUSCGUSMCUSMCRUSNUSNR Are you..?A Sponsor RepresentativeAn Attendee 2. CPE Course Information: Course/Conference Title: Sponsoring Organization: Course Date(s): Course Location: City: State: If multiple dates / locations, please list or explain. (1500 character maximum) 3. I have attached an agenda or outline for this course that includes both topics and times of instruction and breaks.YesNo 4. I have attached a bio for each instructor.YesNo 5. I understand that for a course to be an approved CPE course, there must be CPAs in attendance.YesNo NOTE: PowerPoint presentations and other course materials may also be submitted in addition to an agenda. Attachments:
