By signing this form, I attest that I did participate in this education session, in its entirety. Signature: Date:

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1 The American Public Works Association CEU Request Form MicroPAVER FieldInspector Overview (CLL14) Downloadable Program (.2 CEUs) This is a two part form. For receipt of CEU Credits for downloadable programs, please submit a copy of the completed CEU Request form and the corresponding survey evaluation. CEU Request Forms that are submitted without an accompanying evaluation will not be processed. By signing this form, I attest that I did participate in this education session, in its entirety. Signature: Date: First Name: Middle Initial: Last Name: APWA Membership Number: *Florida License Number (if applicable): Job Title: Employer: Address: City: State/Province: Zip: Address: (required) Phone No. : Cell No.: *IF you hold a PE License in Florida, and would like CEU credit - you MUST include your Middle Initial and Florida License Number on this form. APWA is an approved Florida Board of Professional Engineers training provider The American Public Works Association has been accredited as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102; (703) *CEU requirements for water/waste water operators vary from state to state. Before you send in your CEU application, check with your state certifying agency to see if CEUs from APWA will be accepted. Please direct CEU questions to Heather DelaCruz at (800) You will be notified (via ) when your CEU Transcript has been processed and is available for secure download via APWA s web site at APWA Finance Use Only: imis# Transaction # Last 4 Digits of CC Date If you have a current APWA Membership, there is no charge for CEU registration; however, if you are NOT currently an APWA Member, the cost of CEU registration is $7 USD. Non Members Only please complete the following payment information and submit your payment of $7 (USD) via check, Visa, Mastercard or American Express. Check Box for Receipt (alternate address for receipt: ) Name on Card: Authorized Cardholder Signature: Exp Date: /20 (VISA, MasterCard or American Express) (mo.) (yr.) Please submit a copy of the completed CEU Request form and the survey evaluation to: APWA, Attn: Heather DelaCruz, 2345 Grand Blvd, Suite 700, Kansas City, MO or Fax: (816)

2 The American Public Works Association CEU Request & Evaluation Forms MicroPAVER FieldInspector Overview (CLL14) This is a two part form. For receipt of CEU Credits for downloadable programs, please submit a copy of the completed CEU Request form and the corresponding survey evaluation. CEU Request Forms that are submitted without an accompanying evaluation will not be processed. Please rate the items below by placing an X in the appropriate boxes below. Session Content: Poor Fair Good Very Good Excellent Program Content Relevance of Topic Overall Session Rating After attending this session, I am now better able to: Explain how FieldInspector could be integrated into my agency s pavement management plan. Determine what data is the most valuable. Utilize the tools in the software. Strongly Disagree Disagree Neutral Agree Strongly Agree Skill of speaker(s) in presenting message: Would you recommend to speak again? Poor Fair Good Great Would you recommend to speak again? Yes No Scott McDonald Moderator: Teresa Hon Comments: Please submit a copy of the completed CEU Request form and the survey evaluation to: APWA, Attn: Heather DelaCruz, 2345 Grand Blvd, Suite 700, Kansas City, MO or Fax: (816)

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4 2013 APWA Congress Activities Related To MicroPAVER Entire Conference On the exhibit floor Visit booth #750 For Product Information Tuesday, Aug 27, 11:00 11:30am In The Convention Center Lobby Stop by the DCS Center For purchasing and subscription information Tuesday, Aug 27, 2:30 4:00pm, In Room E26 For MicroPAVER Open forum 2

5 Our Moderator Teresa Hon Professional Development Program Manager APWA Polling Questions If you are in full screen mode, you will need to minimize the screen to vote 3

6 Our Speaker: Scott J. McDonald Direct: +1 (720) Cell: +1 (970)

7 FieldInspector Activation Validation Registration 5

8 Activation Code Activated 6

9 Software Simulation QUESTIONS??? To Ask A Question Type It In The Question Pod At The Bottom Of Your Screen And Hit Submit If You Are In Full Screen Mode You Must Minimize Your Screen To Access The Question Pod. 7

10 Please remember to fill out the online survey at: This program is worth.2 Continuing Education Credits. To request your CEU s you must complete the survey. Thank you! The American Public Works Association has been accredited as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 1760 Old Meadow Road, Suite 500, McLean, VA 22102; (703) APWA Congress Activities Related To MicroPAVER Entire Conference On the exhibit floor Visit booth #750 For Product Information Tuesday, Aug 27, 11:00 11:30am In The Convention Center Lobby Stop by the DCS Center For purchasing and subscription information Tuesday, Aug 27, 2:30 4:00pm, In Room E26 For MicroPAVER Open forum 8

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