Name:*
Email:*
CEU Planner Name:*
CEU Planner Phone:
Seminar Title:*
Speaker:*
Course #, CEU Credits:*
Date:*
Time:*
Place (Name, Address, City):*
RSVP Date:*
RSVP Email:
RSVP Phone:
Logo (Dealer, Sponsor, etc):
Other Details (lunch provided, drinks and appetizers provided, etc.):