EmailMe Form - LTC-2023-CLE-Request Form

CLE REQUEST FORM

ExecuSummit will seek accreditation for up to 8 hours of general CLE credits in the state of Pennsylvania automatically. This will provide via reciprocity up to 8 hours of general credits in New York, New Jersey, Connecticut and California. Other states can/may apply.

It will take up to 30 days after a summit Certificates of Attendance to be sent.

If your state allows you to submit the program on your own, we can provide a Certificate of Attendance and agenda for you to submit to your state.

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5th Annual Long Term Care Insurance ExecuSummit *** September 12 & 13, 2023 *** Mohegan Sun Hotel & Convention Center, Uncasville, CT

Attendee Information:

First Name: *

Last Name: *

Company or Firm Name: *

Phone: *

### - ### - ####

Phone Extension:

Email: *

CC this e-mail on Confirmation:

Enter a different e-mail here if you would like to be cc'd when we e-mail the CLE Documentation.

State(s) Requested

Other

Which Sessions Did You Attend?

Please confirm with sessions you attended. If you attended all simply check the "I attended all sessions" If you attended select sessions please check the ones you attended.

I Attended All Sessions - 8 Hours of General CLE Credits

OR I Attended Only the Following Sessions:

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By checking this box I confirm that I attended the sessions I have indicated.

This box must be checked for your request to be processed.

Comments:

Please fill in the field below and click the submit button.

Your documentation will be e-mailed back to you shortly.

Please note that it takes up to 30 days after a summit for COA's to be emailed.

Please note that the number of sessions will be totaled and then divided by 60 for your total hours up to 8 hours.

Please only hit submit once to avoid duplicate submissions.

Thank You for joining us. We look forward to seeing you again soon.