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Unformatted text preview: Activity Dates Location Total Contact Hours From To Provider if applicable Category Check only one and attach written summary if applicable A. Credit Continuing Education (attach formal documentation from the sponsoring agency) B. Noncredit Continuing Education C. Self-directed Continuing Education II. SIGNATURE I HEREBY CERTIFY that the information provided is true and correct to the best of my knowledge. Signature of Participant Date Mo./Day/Yr....
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This note was uploaded on 12/17/2009 for the course A a taught by Professor A during the Spring '09 term at Dallas Baptist.
- Spring '09