| YOUR NAME: |
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| YOUR EMAIL: |
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| COURSE/MEETING TITLE: |
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| COURSE#: |
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| INSTRUCTOR: |
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| EVENT DATES
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| DAYS: |
Sun,
Mon,
Tue,
Wed,
Thu,
Fri,
Sat
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| START TIME: |
AM
PM
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| STOP TIME: |
AM
PM
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| START / END DATES |
/ |
| INTERMEDIATE DATES: |
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| EXCEPTION/HOLIDAY DATES: |
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| PLEASE INDICATE
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| COURSE TYPE: |
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| # CREDITS (if any): |
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| CEU's (if any): |
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| CHECK ALL THAT APPLY: |
Meeting
Workshop
Satellite
Training
|
| INDICATE THE HOST SITE & ALL RECEIVE SITES
|
| HOST SITE |
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| RECEIVE SITE (1) |
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| RECEIVE SITE (2) |
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| RECEIVE SITE (3) |
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| RECEIVE SITE (4) |
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| OTHER SITES: |
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| COMMENTS: |
|
| |
