Attendee’s Name: - The Georgia Society of CPAs
√ Attendee’s Name: Presentation Name:
√ GSCPA Number: Presentation Date: City:
Firm Name: Instructor(s):
Street Address: Total CPE Hours:
City/State/Zip: Accounting & Auditing Hours: 1
(if applicable)
Office Phone: Total Amount Received: $
I certify that I attended the presentation listed above and that I should be credited with CPE hours on the Georgia Society of CPAs records.
√ Please Print Name: Please Print Representative’s Name:
√ Participant Signature: Chapter Representative’s Signature:
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