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2014 APC/PennDOT Fall Seminar
PDH REQUEST FORM
THE FOLLOWING FORM IS FOR USE TO REQUEST PROFESSIONAL DEVELOPMENT HOURS FOR 2014 APC/PENNDOT FALL SEMINAR WORKSHOPS.
Upon submission, you will receive an email confirmation.
The confirmation email IS YOUR PDH CERTIFICATE so please print it for your records.
All Requests must be submitted by 5:00PM on JANUARY 31, 2015. NO Requests will be acknowledged after this time.
Name
*
First
Last
Company
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
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Republic of the Congo
Djibouti
Egypt
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Kenya
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Libya
Madagascar
Malawi
Mali
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Morocco
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Namibia
Niger
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Senegal
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Country / Region
Email
*
Confirm Email
Phone
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Professional Development Hours
Select the Workshops you attended at the APC/PennDOT Fall Seminar on November 20, 2014.
I request a PDH Certificate for the following Fall Seminar Session 1 Workshop.
*
Please select
Structures - 1.5 PDH
Contract Administration - 1.5 PDH
Safety Topics - 1.5 PDH
PA Turnpike Commision - 1.5 PDH
Projects Using Innovation & Technology - 1.5 PDH
None Attended - 0 PDH
I request a PDH Certificate for the following Fall Seminar Session 2 Workshop.
*
Please select
Structures - 1.5 PDH
General Highway Construction Issues - 1.5 PDH
Workforce Development - 1.5 PDHs
Consultant Focus - 1.5 PDH
Innovative Construction Management - 1.5 PDH
None Attended - 0 PDH
I verify I was a registered attendee of the 2014 APC/PennDOT Fall Seminar and attended the Workshop Sessions selected above.
*
YES