2023 Fall Convention Attestation Form

Today's Date(Required)

MM slash DD slash YYYY

Total CEU Hours Available for the 2023 Nevada Health Care Association Fall Convention and Trade Show 12 CEUs total (6 CEUs for Wednesday, October 26th & 6 CEUs Thursday, October 27th)

I am requesting:(Required)

(If you did not attend both days, please do not request the full CEU amount)

I want my CEU request reported to:(Required)

NAB

BELTCA

Other

List other NV State Boards(Required)

NAB ID

BELTCA ID

Attestation(Required)

By checking the attestation box below and digitally signing your name, you attest that all information entered is accurate and that you attended the event in-person for the number of CEU hours requested.

I attest

Your Name(Required)

First Last

Your Email(Required)

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Sep 25Cultural Competency Training (Wed)
Oct 23Cultural Competency Training (Wed)
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