MONTHLY DINNER, EDUCATIONAL MEETING, WORKSHOP, SEMINAR OR MINI-CONFERENCE

REGIONAL NAME NAMES OF SPEAKER(S)

Date Type (Meeting, Seminar, etc.)

Total Hours=

No. Name - Please Print Company Name Region Guest Y/N PD-Specify Region Use

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MUST ATTACH MEETING/EVENT NOTICE TOTALS (THIS PAGE ONLY) [ =REGIONAL] [ =NON-MEMBERS] [ [ =P.D.'S]"We certify that the above information to be correct and true to the best of our knowledge." Date:____________

_____________________________________________________________________________________President Preparer

Reg 403

MONTHLY EDUCATIONAL MEETING, WORKSHOP, SEMINAR OR MINI-CONFERENCE

ATTACHMENT - PAGE ______ OF ______REGIONAL NAME

Date Type (Meeting, Seminar, etc.)

No. Name - Please Print Company Name Region Guest Y/N PD-Specify Region Use

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TOTALS (THIS PAGE ONLY) [ =REGIONAL] [ =NON-MEMBERS] [ =P.D.'S]

MEMBERS SPEAKING OR REPORTING AT EDUCATIONAL MEETING

REGIONAL NAME

Date

No. Name - Title (Please Print) Report Topic, Committee, Peer Share, Etc. Region PD-Specify Region Use

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101112131415

MUST ATTACH MEETING/EVENT NOTICE TOTALS (THIS PAGE ONLY) [ =REGIONAL] [ =NON-MEMBERS] [ =P.D.'S]"We certify that the above information to be correct and true to the best of our knowledge." Date:____________ Hours:

Mini-Work = 1 or less

Ed. Meeting = 1hr.

_____________________________________________________________________________________ Workshop = 1-3

President Preparer Sr. CEA Director Seminar/Conf = 3+