SAFE-D Webcast Credit Application

SAFE-D Credit Application
I certify that I participated in the "Ken Campbell - Ask Me Anything" on-demand training and am entitled to receive one (1) hour of ESD Commissioner Training Credit. I understand that false statements on this application may lead to significant penalties.

PLEASE ALLOW 4-6 WEEKS FOR PROCESSING.
Keyword*
Name*

First NameLast Name
E-mail*
County*
ESD Name*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
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Comments about this training?
Use your mouse (on your PC) or your finger (on your mobile device) to sign the form.
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NEW: BEFORE you click SUBMIT below, click the PRINT FORM button (below) to print the form for your records until you receive an emailed form from VG Young Institute.
This form will be available for 30 days after the training. After 30 days, credit application will not be available. Please note: Payment must be received for credit hours to be processed. Educational sponsor: V.G. Young Institute of County Government, Texas A&M AgriLife Extension Service.
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SAFE-D Credit Application