Fillable CEU Reg Form NEW.BRN Updated 5.10.16 Meeting sign-in sheet

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CEU Reg Form NEW.BRN Updated 5.10.16 Meeting sign-in sheet

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CENTRAL CALIFORNIA TRAINING ACADEMY – CONTINUING EDUCATION CREDIT (CEU)
REGISTRATION AND ATTENDANCE FORM
T
HIS COURSE MEETS THE QUALIFICATIONS FOR
(
)
HOURS OF CONTINUING EDUCATION CREDIT FOR
BRN
AS REQUIRED BY THE
C
ALIFORNIA
B
OARD OF
R
EGISTERED
NURSING. PROVIDER NO. CEP 13140
A CEU confirmation Letter will be emailed to you 7 - 10 working days after you’ve completed the CEU requirement.
Incomplete registration will result in a forfeiture of credits.
Title: Date(s):
Instructor(s): Location:
Print Name
License No.
E-Mail
Daytime Phone
Signature
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CEU Reg Form NEW.BRN Updated 5.10.16 Meeting sign-in sheet

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Completed 21 May 2020

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