OFFICIAL RECORD OF ATTENDANCE

Provider: Smartsettle Division of ICAN Systems Inc.
Phone: 604-852-6941, Fax: 604-852-0909
Canada: PO Box 8000 # 611, Abbotsford, BC V2S 6H1
USA: PO Box 8000 # 611, Sumas WA 98295 – 8000

Please print, complete with clear printing, sign this form and fax to Smartsettle in order to verify that you attended the activity indicated and completed all assignments required for the eligible credit hours.

Title of Activity: Smartsettle Facilitator Training Level (s)_________ (I - V)

Participation beginning date: _________________________

Participation completion date: _________________________

Eligible Credit Hours: _________

Organization recognizing credit hours: ________________________________________

Membership or Bar No. ____________________

Name of Attendee: ________________________

Attendee Signature: ________________________

Note: Provider keeps this record of attendance for at least 4 years after the date of completion of this activity.