Amt Individual Ce Recording Form printable pdf download

Amt Individual Ce Recording Form

AMT INDIVIDUAL CE RECORDING FORM

Name_____________________________ AMT ID # ____________ State License #_____________

(if applicable)

Conference Name____________________________ Conference Location___________________

Session #

Date

Session Title

# Clock

Hours

Total # of Clock Hours_______________

Please note: This is your copy. Please do not submit. If you wish to document your CE activities online through AMT’s new

recording system, AMTrax, you may do so by accessing the AMT website: Should you not

have access to the Internet and wish to use AMTrax, you may submit this form to the AMT office by fax: 847-823-0458 or

mail. For members who have to comply with AMT’s Certification Continuation Program (CCP), we strongly encourage you to

use AMTrax as a recording mechanism. Please keep a copy for your records in case you are audited.

________________________________________________________________________________

My signature attests to my attendance at the above courses/sessions

Date

________________________________________________________________________________

Signature of conference official

Position/Office

Date

(If applicable for state licensure)

Amt Individual Ce Recording Form