To be awarded IRS CE credits, you must provide the information below. This form must be completed within 30 days of the program date.

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* 1. Program Title:

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* 2. Program Date:

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* 3. First name (as registered with the IRS):

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* 4. Last name (as registered with the IRS):

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* 5. PTIN number:

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* 6. Email address:

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* 7. Firm/Company:

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