CCE Workshop Registration

Registration Type

First Name

Please capitalize first letters only. This field will be used for CEU/PDU Certificates.

Last Name

Please capitalize first letters only. This field will be used for CEU/PDU Certificates.

Chosen First Name

Complete this field only if your Chosen First Name is different than your First Name.

Chosen Last Name

Complete this field only if your Chosen Last Name is different than your Last Name.

Date of Birth

MM/DD/YYYY - Used to match registrant records

Phone

Email

This email address will be used for all workshop communications

Re-type email

City

State/Province

ZIP/Postal Code

Country

Please provide the Names & Email Addresses of the Additional Attendees for the Group Rate. Additional Attendees listed will receive a separate email invitation to register (pre-paid).