Application for Continuing Education (CE)

Fields marked with an asterisk* are required and must be completed prior to clicking Pay Now.

A $4.50 Convenience fee will automatically be added to your total.

Organization Name

First Name

Last Name

Email

@

Phone Number

#

Address

City/Town

State/Province

ZIP/Postal Code

Date you submitted your electronic CE Application to the Board.

In-person Continuing Education Application $50.00 per course

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Online Course Application/Addendum $50.00 per online course

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List the courses you are submitting payment for