2012 ISPE Annual Meeting
11-14 November 2012
Please complete and submit this form along with your evaluation forms.
Evaluations are required for everyone wishing to claim CEUs. Thank you!
Print Name______________________________ISPE ID# (optional)___________________
Company _______________________________Email ______________________________
Please list each Session you attended. Each ½ day is credited with 0.3 CEUs (3 contact hours).
Session Title
Sunday
PM
Monday
AM
PM
Session Title
Tuesday
AM
PM
Wednesday
AM
PM
As an industry professional, I verify that I have attended each of the sessions that I have indicated and
therefore qualify for the continuing education credit specified for each. I understand that I may access my
certificate from my ISPE Web Site Profile Page anytime after 1 January 2013.
Signature __________________________________________ Date ____________________
Please submit to the registration desk or fax to +1-813-264-2816 by 1 December 2012.
NEW! Access your Certificate(s) on your ISPE Web Site Profile Page!