SAFE-D Bexar County Aug. 18 Credit Application

SAFE-D South Texas Regional Workshop '21 Credit Application
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Aware that false statements may incur penalties, I certify that I participated in the South Texas Regional Workshop on June 26, 2021 and am entitled to 3 (three) hours of Commissioner Training Credit.
Name *

First Name Last Name
E-mail *
County *
ESD Name *
Example: Buffalo County ESD No. 100
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
How would you rate the value of this training?

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What suggestions do you have to improve this training?
Use your mouse (on your PC) or your finger (on your mobile device) to sign the form.
Signature

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NOTE: Before you click SUBMIT below, you may click the PRINT FORM button (below) to print the form for your records. You will be emailed a confirmation. Print that email for your records until you receive a certificate from V.G. Young Institute of County Government.

PLEASE ALLOW FOUR TO SIX WEEKS FOR PROCESSING.
This form will be available for 30 days after the event. 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 South Texas Regional Workshop '21 Credit Application