Florida Engineering Society

Chapter PDH Application

Instructions:
Please submit this application to FES headquarters at least 6 weeks prior to your chapter or regional meeting. The FES Professional Development Committee will respond in approximately 3 weeks of receipt at FES headquarters.
Contact Name of Person Submitting Chapter PDH Application:

First Name *		Last Name *
Email Address *		Event Type: *	Chapter Event Regional Meeting Other
Chapter Name OR Region Number *
Location of Chapter Event (agency/address):

Address Line 1 *
Address Line 2
City *		State *
Zip/Postal Code *		Chapter Event Location Phone Number: *
Event Title: *		Event Date: *
Event Start Time: *		Event End Time: *
Number of PDHs Applied For (1 PDH = 50 minutes in the classroom) *
Technical Area of Practice *	Mechanical Electrical Civil Environmental	Other
Name of Speaker

Professional Title *
First Name: *
Last Name: *
Speaker Resume/Bio: *
Estimated Attendance: *
Proposed Handouts or Presentation: *
Presentation Description (please provide 2-3 sentences): *	300 of 300 characters remaining
Agenda/Course Outline: *
Additional Notes: *	300 of 300 characters remaining

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