Event Sign-in and Sign-out Form

All participants that are seeking a certificate of completion or attendance must sign-in and sign-out of each day of each course or conference. Thank you.

I am... *

Signing In

Signing Out

First Name *

Last Name *

Participant's Email Address (Please ensure it matches the email used during registration.) * 🛈

Confirm Email Address * 🛈

Sign-in Code Provided by Instructor *

Sign-out Code Provided by Instructor *

I understand that in order to received professional continuing education credits or a certificate of attendance that indicates the hours attended, I must pay the continuing education fee that is required for my event and I must provide any required information for my profession. Please note that for our conferences, payment for the CE credits will be made after the conclusion of the conference. (If you are unsure if you did, please double check your registration or email ceu@icdl.com to inquire.) *

I acknowledge the above statement

Are you using a device with a touch screen? *

Yes

Signature *

clear

By typing my name below, I am affixing my electronic signature to this form. *

Date Submitted (US Eastern Time Zone) *