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02/28/2019
1:00 PM - 2:00 PM
Nassau County Bar Association - Mineola, NY
NEW YORK CLE CREDIT FOR NONTRADITIONAL FORMAT COURSE
I,
,acknowledge receipt of the course materials for:
I certify that I have listened to and/or viewed the above course in its entirety. Therefore, I request that I be awarded the applicable number of New York CLE credits for this course.
Format (check one)
CD
Member (check one)
NCBA Member
DVD
On Demand
Non-Member
COURSE CODE
During the course or program you will see and/or hear a CLE code(s). Please enter the code(s) in the above field. If you do not include the code(s), you will not be awarded New York CLE credit. Please call 516.747.4464 if any questions
Date of completion of CLE course
Address:
Phone:
Email:
To obtain New York CLE credit, please complete and sign this form and then submit it to the above CLE provider. Once your participation is verified by the provider, a New York CLE Certificate of Attendance will be issued to you by the provider. • New York attorneys should retain a copy of this affirmation along with their New York CLE Certificate of Attendance. • Please note that in New York, one hour of CLE credit consists of at least 50 minutes of instruction. Credit hours must be calculated in no less than 25- minute (.5-hour) increments.
The undersigned affirms that he/she has:
watched the DVD in its entirety on
viewed the On Demand title in its entirety on
Date of seminar:
COURSE CODE:
During the course or program you will see and/or hear a CLE code(s). Please enter the code(s) in the above field.
To obtain Part 36 certification, please complete and sign this form and then submit it to the above CLE provider. Once your participation is verified by the provider, a New York CLE Certificate of Attendance will be issued to you by the provider