Meeting/lecture Sign In Sheet Template

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Sign-In Sheet
Sponsors: Please return the completed sign-in sheet(s) within 30 days after the educational program/activity. The
program evaluation must accompany the sign-in sheet(s) in order for credit to be posted to the participant’s continuing
education record.
Name of Sponsor: ____________________________________________________________________________________
Name of Meeting: ____________________________________________________________________________________
Lecture Title: ________________________________________________________________________________________
Date: ____________________________ Location: _________________________________________________________
a.m. session ( )
p.m. session ( )
ABC credentialed individuals are required to print their name clearly, sign and list certification or registration title
and number in order to receive credits.
Print Name
Signature
ABC Title and #
Other Title and #
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
___________________________|___________________________|______________________|_____________________
Page # _______ of _______

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