Application for IAPF Continuing Education Credits for a MULTIPLE DAY (More Than One) Event
Note: This form should be submitted by host or sponsor of the event
Name of Clinic/Event
Date(s) of Event
Location of Event
(Place, Street Address, City, State/Province)
Phone Number
Contact Person
xxx-xxx-xxxx
Contact Email
example@example.com
Name of Primary Clinician
Names of Additional Clinicians
Sponsor of Clinic
Schedule of DAY ONE
Actual Time/Hours (if different than those listed)
Title of Presentation
Name of Clinician
Number of CE Credits
(For CE Committee Only)
8 am - 9 am
9 am - 10 am
10 am - 11 am
11 am - 12 Noon
12 Noon - 1 pm (Lunch?)
1 pm - 2 pm
2 pm - 3 pm
3 pm - 4 pm
4 pm - 5 pm
5 pm - 6 pm
TOTAL
Schedule of DAY TWO
Actual Time/Hours (if different than those listed)
Title of Presentation
Name of Clinician
Number of CE Credits
(For CE Committee Only)
8 am - 9 am
9 am - 10 am
10 am - 11 am
11 am - 12 Noon
12 Noon - 1 pm (Lunch?)
1 pm - 2 pm
2 pm - 3 pm
3 pm - 4 pm
4 pm - 5 pm
5 pm - 6 pm
TOTAL
Schedule of DAY THREE
Actual Time/Hours (if different than those listed)
Title of Presentation
Name of Clinician
Number of CE Credits
(For CE Committee Only)
8 am - 9 am
9 am - 10 am
10 am - 11 am
11 am - 12 Noon
12 Noon - 1 pm (Lunch?)
1 pm - 2 pm
2 pm - 3 pm
3 pm - 4 pm
4 pm - 5 pm
5 pm - 6 pm
TOTAL
Schedule of DAY FOUR
Actual Time/Hours (if different than those listed)
Title of Presentation
Name of Clinician
Number of CE Credits
(For CE Committee Only)
8 am - 9 am
9 am - 10 am
10 am - 11 am
11 am - 12 Noon
12 Noon - 1 pm (Lunch?)
1 pm - 2 pm
2 pm - 3 pm
3 pm - 4 pm
4 pm - 5 pm
5 pm - 6 pm
TOTAL
Use this space to provide additional information about the event.
If a flyer is available, please upload it here
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