COURSE ATTENDANCE VERIFICATION

Participant's Name: Josh Quila

State and License #: 123

Participant AGD ID#: 123

Course: Core Values

SPEAKERS: Sara Ritchie

Educational Method: Self Study

CE Hours: 1

Educational Type: Self Study

Course Date: March 4, 2022

AGD Code:

550 Practice Management and Human Resources

Verification Code: F101

Authorized Signature:

PARTICIPANTS:

This activity has been planned and implemented in accordance with the standards
of the Academy of General Dentistry Program Approval for Continuing Education (PACE)
through the joint program provider approval of Delivering WOW and Dentalflix.
Delivering WOW is approved for awarding FAGD/MAGD credit.

Keep this form for your records.

AGD Members: Delivering Wow will submit attendance verification to the AGD on your behalf.
Please allow at least 30 days for documentation of participation to be added to your transcript