CBSPD Application for CEU Approval

Name*
Phone Number
Fax Number
E-mail Address to send your CEU approval letter (in pdf) to*
Enter the Address that the CBSPD CEU Committee should mail information to:
Title
Facility Name*
Address*
Street Address City State ZIP Code
Program Information *Note: If you have a brochure, please e-mail it to us at ceu@sterileprocessing.org
Program Title*
Program Duration ( weeks, days, hours..etc )*
*Note: If over two (2) hours, a program agenda is required. Ex: 8-10AM "Prog. Title", 11-12PM "Prog. Title", etc.
Date(s) of Program(s):*
Program Location
Speakers and Titles of Talks*
Goals of Program*
Comments