Official Record of Attendance for Continuing Legal Education Credits (CLE) for Live Webinar
Submission of this form and payment are required for Strafford to process your credit
Provider: Strafford, 590 Dutch Valley Rd. NE, P. O. Box 13729, Atlanta, GA 30324-0729
Date:
Conference Title:
Duration: 1:00
PM to 2:30
PM, Eastern Time
NAME OF ATTENDEE
(PLEASE TYPE OR PRINT)
CLE STATE(S)
REQUESTED
STATE BAR ID
EMAIL ADDRESS TO SEND
CERTIFICATE(S)
SIGNATURE
State 1
1.
State 2
Your signature above is your attestation that you listened to
the entire seminar.
State 1
2.
State 2
Your signature above is your attestation that you listened to
the entire seminar.
State 1
3.
State 2
Your signature above is your attestation that you listened to
the entire seminar.
State 1
4.
State 2
Your signature above is your attestation that you listened to
the entire seminar.
MAIN REGISTRANT:
Name:
Firm Name:
Firm Address:
RETURN FORM WITHIN 7 DAYS:
FAX: 678-399-2970
EMAIL: CLE@straffordpub.com
MAIL: Strafford, P.O Box 13729 Atlanta, GA 30324
FFICE USE ONLY - Listening time:
Program registration does not include payment for optional CLE processing. CLE
credit processing is $65.00 per person per state requested. Unless completed below, we will
bill the main registrant on this program for all attendees requesting CLE credit processing.
CLE payment was made upon registration CLE payment information is below
___________________________________________________________________________
CLE PROCESSING PAYMENT OPTIONS (CHECK ONE):
CLE credit processing for this program @ $65 per person, per state = $ (Amount Due)
Check (make payable to Strafford)
Credit Card:
MC Visa AMEX Discover
Account No:
Exp. Date:
Billing Address:
Signature:
For NY only: CLE is not available for attorneys admitted within the last 2 years.
We will inform participants of the number of credits awarded upon approval of the
program by your state(s).
Approval times for credits vary by state.
Please make copies of this page to list any additional attendees
CLE CODE ANNOUNCED BY PROGRAM MODERATOR:
Please complete this
form and sign it
before returning it to
Strafford.
HIPAA Audits and the New Audit Protocol
