CPE Applicant's Information: Full Name *

CPE Applicant's Information: Title *

CPE Applicant's Information: Credit Union Name *

CPE Applicant's Information: Address *

CPE Applicant's Information: City/State/Zip *

CPE Applicant's Information: Phone Number *

CPE Applicant's Information: Email Address *

Number of Minutes Attended: *

Electronic Signature (required) *

By checking this box, I certify that I am the individual applying for CPE credit and have completed the course as indicated above.

DISCLAIMER

NACUSAC is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org