google-plus
facebook
instagram
twitter
vine
youtube
vimeo
flickr2
linkedin2
pinterest2
wordpress
Skip to Main Navigation
Skip To The Main Content
Skip to Site Footer
FIND A DENTIST
Contact Us
Join/Renew
Login
Search
Menu
Menu
Member Center
Join or Renew
Member Benefits
New Member Benefit
Discount Programs & Endorsed Partners
Member Directory
GDA Career Center
Marketplace
Events & CE
GDA Convention & Expo
Renewing Your License
Live CE: In-Person
CE: Virtual & On-Demand
Expanded Duties
District/Study Club CE
Required CE Courses - Opioid, LEAP, Sedation
New DEA Requirement - MATE Act Info
GDA PLUS+
Health Insurance
GDA Plus+ Supplies/IDBG
Advocacy
Legislative Advocacy
Current Initiatives
GDA's Prescribe with Care Initiative
Contact Dentist Program
LAW Day
GDAPAC
Find Your Legislator
Legislative Insider
Latest News
Action Journal
Contact the Editor
Advertise with GDA
GDA Career Center
Marketplace
About GDA
Leadership & Governance
House of Delegates
2024 GDA Officers
Volunteer Opportunities
Special Olympics, Special Smiles Program
GDA Staff
GDA Leadership Academy
GDA Foundation for Oral Health
Hats & Horses Derby Gala
Fundraising Events
Healthy Mouth, Healthy Me!
Public Resources
Find a Dentist
Charitable Clinics
Donated Dental Services
Oral Health FAQs
Emile T. Fisher Foundation
Home
/
Events & CE
/
District/Study Club CE
/
CE Certificate Request Form
District/Study Club Request for Verification of Participation Forms
This form must be completed at least 30 days prior to the scheduled CE event.
Anyone submitting this form must review the
CE Event Minimum Standards
. By submitting this form you are attesting and confirming that your CE event meets the minimum standards.
Name of District or Study Club
Click to add
(?)
Organizer's Name
Click to add
(?)
Organizer's Phone
Click to add
(?)
Organizer's Email
Click to add
(?)
Meeting or Presentation Title
Click to add
(?)
Meeting Location
Click to add
(?)
Meeting Date
Click to add
(?)
CE Hours/Credits
Click to add
(?)
Presenter's Name
Click to add
(?)
Presenter's Title/Credentials
Click to add
(?)
Presenter's Phone
Click to add
(?)
Presenter's Email
Click to add
(?)
Presentation Synopsis (or attach)
Click to add
(?)
By submitting this form you are attesting and confirming that the CE event meets the minimum standards above.
I Attest and Confirm
Member Center
Join or Renew
Member Benefits
New Member Benefit
Discount Programs & Endorsed Partners
Member Directory
GDA Career Center
Marketplace
Events & CE
GDA Convention & Expo
Renewing Your License
Live CE: In-Person
CE: Virtual & On-Demand
Expanded Duties
District/Study Club CE
Required CE Courses - Opioid, LEAP, Sedation
New DEA Requirement - MATE Act Info
GDA PLUS+
Health Insurance
GDA Plus+ Supplies/IDBG
Advocacy
Legislative Advocacy
Current Initiatives
GDA's Prescribe with Care Initiative
Contact Dentist Program
LAW Day
GDAPAC
Find Your Legislator
Legislative Insider
Latest News
Action Journal
Contact the Editor
Advertise with GDA
GDA Career Center
Marketplace
About GDA
Leadership & Governance
House of Delegates
2024 GDA Officers
Volunteer Opportunities
Special Olympics, Special Smiles Program
GDA Staff
GDA Leadership Academy
GDA Foundation for Oral Health
Hats & Horses Derby Gala
Fundraising Events
Pull for Smiles Clay Shoot
Healthy Mouth, Healthy Me!
Public Resources
Find a Dentist
Charitable Clinics
Donated Dental Services
Oral Health FAQs
Emile T. Fisher Foundation
"State":"GA"