INSTRUCTIONS THIS ATTENDANCE FORM IS A HIGHLY VISIBLE DOCUMENT

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WFAS Conference

INSTRUCTIONS

This attendance form is a highly visible document during a conference. PDA staff will assist in formatting the information and making the handout attractive. We have indicated in red where decisions need to be made. Graphics and color schemes are the choice of the provider.

Need help? Contact:

Kacie 904-674-2472 [email protected]

June 904-674-2498 [email protected]




Conference Title


Date

Location


Participant Attendance Verification Form


In each session below, initial the course you attend. To verify your attendance, return this form to the CEU table

before departing. The NCCAOM Certificate of Participation will be emailed to you after the conference.


NAME:


Presentation

PDA Pts

NCCAOM

Category

Initial

Attended


Day - Date




8:00 am - 9:00 am

Presentation Title, Speaker Name, Credentials (Education, Certification, Licensure)




9:00 am – 10:30 am

Acupuncture and Chinese Herbology, Jane Doe, MSAc, Dipl. O.M. (NCCAOM)®, L.Ac.








10:30 am – 11:00 am

Break













12:30 pm – 2:00 pm

Lunch & Exhibits
































Conference Title

Date

Page 2


Presentation

PDA Pts

NCCAOM

Category

Initial

Attended


Day - Date






























































NAME:

E-Mail Address:


NCCAOM PDA Provider # _______

INSTRUCTIONS THIS ATTENDANCE FORM IS A HIGHLY VISIBLE DOCUMENT

NCCAOM PDAs AOM-BIO

NCCAOM PDAs CW-PE

TOTAL NCCAOM PDAs Awarded


To verify your attendance, return this form to the CEU table before departing.

The NCCAOM Certificate of Participation will be emailed to you after the conference.


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