IPT Local Luncheon Group Post-Program Submission

Post Program Report - Local Luncheon Groups

This form is to be used AFTER the program for final reporting and compliance with the requirements as set forth in the Local Luncheon Continuiong Education Manual.

1. Contact Name:

2. Contact Phone Number:

3. Name of Local Luncheon Group:

4. Contact E-mail: This question requires a valid email address.

5. Date of Meeting:

calendar

6. Time of Meeting:

7. Location of Meeting (Venue, City and State):

8. Total Instructional Time in minutes: This question requires a valid number format.

10. Topic/Title of Luncheon:

11. Please upload a copy of the promotional materials:

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12. Please upload a copy of the completed Sign-In Sheet(s): (Names of all attendees)

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13. Please upload any other information that you feel may be needed and is not included in the above:

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14. Please add any comments or questions:

By submitting this form, I verify the time the speaker presented and am submitting the Local Luncheon sign–in sheet along with other required documentation after this program for the IPT files.

15. By typing my name in this box, I am signing this document. When I click the "submit button", this form will be sent to Jake Lipps, Christina Webb, Cassandra Albert and Brenda Pittler in the IPT office. *This question is required.

IPT Local Luncheon Group Post-Program Submission

Local Luncheon Group Program Notification