NEW HAMPSHIRE BOARD OF LICENSURE FOR PROFESSIONAL ENGINEERS

CONTINUING PROFESSIONAL DEVELOPMENT - ACTIVITY LOG

Licensee:
PE License No.: State:
Expiration Date:

FOR THE PERIOD
From: To:
Page No. of

Activity
Number
#
DATE(S)
OR
DATE RANGE		 NATURE OF ACTIVITY AND SPONSORING ORGANIZATION

LOCATION AND SPEAKER/INSTRUCTOR (AS APPLICABLE)

 PDH'S
FOR THIS ACTIVITY

CUMULATIVE PDH'S FOR THIS PERIOD