Attendance List

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Fill out this attendance list with information from your in-office MOBI or TIES training. You still must mail the attendance list with initials to the MOBI/TIES Office. The paper form is required for participants to receive continuing education credit. If you do NOT receive an email confirmation, your form did NOT submit.

If you are a physician, nurse or health care worker seeking information on a MOBI or TIES training contact the MOBI/TIES Office.

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  Printed Name (First, MI, Last) Profession
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