lntroduce Yourself and Your Event

Name

Position or Title

Name of Organization

Email Address

Please provide general details such as topic, date, CEU available, target audience

CEU, CME, etc. Offered CEU, CME, etc. Offered Yes No Undecided

Live or On Demand Event Live or On Demand Event Live On Demand Both (On Demand after event) Undetermined

Event Date(s)