Participant Demographics and Attestations

Participant demographics:

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* 1. Full Name:

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* 2. Please indicate credentials

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* 3. What type of certificate do you wish?

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* 4. Florida license number for CE Broker reporting:

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* 5. How many credit(s) are you claiming:

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* 6. I attest that I have watched the EPA and New Evaluation webcast video.

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* 7. I attest I completed the EPAs and New Evaluation independent reading.