CNE Application Form-Individual Activity

CNE Application - Individual Activity

Please complete the form below to submit your CNE Application
Full Name *

First Name Middle Name Last Name
Current Address

Company Name

Street Address

City State / Province

Postal / Zip Code Country
Email Address *
IMPORTANT INFORMATION:

$75 per content hour for programs 0.5 – 5 contact hours

$65 per content hours for programs 5.5-10 contact hourst

$60 per content hours for programs 10.5 and above contact hours

For questions about content contact hours, please contact education@ctnurses.org to determine your fee.

29 to 15 business days prior to the presentation date - Additional fee

Expedient fee $250

14 to 7 business days prior to the presentation date, Additional Fee

Expedient fee 500
Phone Number

Area Code Phone Number
Title of Activity *
Please type in title of activity submitted
Start date

Month Day Year
Upload CNE Application

Upload a File
pdf, doc, docx, jpg, png, gif Cancel of

My Products

1-5 hrs per contact hour $75.00 $ 75.00

Quantity

.5 Contact hour price $37.5 $ 37.50

6-10 contact hours $65 $ 65.00

Quantity

.5 for over 5 contact hours 32.5 $ 32.50

11 and above $60 $ 60.00

Quantity

.5 for over 10 contact hours $30.00 $ 30.00

Expedient Fee $250 for 29-15 Business days submission $ 250.00

Expedient Fee $500 for 14- 7 Business day submission $ 500.00

late fees

Total $ 0.00

CNE Application - Individual Activity