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HTML Preview Training Class Sign In Sheet page number 1.

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P-77

[4/1/2013]

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CONTINUING EDUCATION TRAINING (CET) CLASS

SIGN-IN ATTENDANCE SHEET

HDOA - Pesticides

Branch

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Date:

Class

No:

Title:

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Approved

Categories:

No.

of

Credits

Approved:

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Sponsor

/

Contact

Person:

Instructor(s):

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Time

Started:

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[PARTICIPANTS MUST SIGN CORRESPONDING SIGN-OUT SHEET AT END OF SESSION TO RECEIVE CREDITS]

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Time In Print Name

Company

Certification No.

and Categories

Expiration

Date

Signature

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