Washington Insurance Continuing Education Attendance Register Page #

Total pgs
Provider Name
Provider Number
Course Title
Course Number
Class Date Class Location
ATTENDEES Arrive Depart
First and Last Name WAOIC Number Phone Number Time Signature Time Initials
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Instructor or Monitor - Name Signature Date
Maintain this document for three years. CEATTREG1/2014