CEU Course Registration

IDCEC CEU Instructor Form

Please fill out and submit the form below to begin Clarus™ CEU Instructor registration and training.

Your Name:*
Company Name:*
Phone:*
Position at Company:*
Email Address:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
References

References may not be from co-workers at the same company, university or firm.
Reference 1 Name:*
Company Name:*
Phone:*
Position at Company:*
Email Address:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Reference 2 Name:*
Company Name:*
Phone:*
Position at Company:*
Email Address:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
About You
Courses taught in the past two years:*
A brief biography about yourself:*
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.