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Please apply for ONLY ONE meeting per form and carefully type all requested information. Thank you.

Contact Name: Address of Contact:
Contact Email: City:
Contact Phone: State:
Contact Fax: Zip:
Meeting Title: Open to Public?: yesno Fee: $
Is this a previously approved meeting?: yesno

If yes, provide tracking number:
and date held:

Program Information: Please complete the required information below. To convert minutes to CEUs, please see the CEU conversion table at the top of the page.

Meeting Location:
(ie.Hotel name, convention center, etc.)
Address:
City:
Date(s): State:
Time(s):

Zip:

Continuing Education Units Requested by Category:
Nutrient Management: Pest Management: Professional Development:
Soil & Water Management: Crop Management: Total CEUs Requested:

List the states you wish to apply for CEUs in:

Please refer to CEU application instructions and indicate if you are applying for:
Local Board CEUsInternational CEUs (6 or more states attending)

Session and Meeting Information

Session Title:
Session Date 1:

Session Start Time:

Session End Time:

CEU Area:
NWSWPMCMPD

CEU credit:

Session Summary (attach if needed)

Speaker Name/Background (attach if needed)




2nd Session Title:
Session Date 2:

Session Start Time:

Session End Time:

CEU Area:
NWSWPMCMPD

CEU credit:

Session Summary (attach if needed)

Speaker Name/Background (attach if needed)


3rd Session Title:
Session Date 3:

Session Start Time:

Session End Time:

CEU Area:
NWSWPMCMPD

CEU credit:

Session Summary (attach if needed)

Speaker Name/Background (attach if needed)



4th Session Title:
Session Date 4:

Session Start Time:

Session End Time:

CEU Area:
NWSWPMCMPD

CEU credit:

Session Summary (attach if needed)

Speaker Name/Background (attach if needed)



5th Session Title:
Session Date 5:

Session Start Time:

Session End Time:

CEU Area:
NWSWPMCMPD

CEU credit:

Session Summary (attach if needed)

Speaker Name/Background (attach if needed)



6th Session Title:
Session Date 6:

Session Start Time:

Session End Time:

CEU Area:
NWSWPMCMPD

CEU credit:

Session Summary (attach if needed)

Speaker Name/Background (attach if needed)


Done

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