Attendance Sheet For PRC CPD Activity
Attendance Sheet For PRC CPD Activity
Attendance Sheet For PRC CPD Activity
ATTENDANCE SHEET
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Certified Correct by: Concurred by:
______________________________ ______________________________
(Signature Over Printed Name) (Signature Over Printed Name)
CPDD-12-B
Rev. 00
June 29, 2020
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CPD Provider’s Authorized Representative CPD Provider’s Authorized Representative
Date and Time: Date and Time:
CPDD-12-B
Rev. 00
June 29, 2020
Page 2 of 2