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Certificate of Completion

This certifies that the individual named has successfully completed the course requiremnt for:

Student Name: [fname] [lname]

S.S. Number or License Number: [answer_S.S. Number or License Number]

Course Name: [event_name]

Date of Course: [start_date]

Provider Name: [provider_name]

Provider Number: [provider_number] Number of Credits: [number_credits]

Address: [venue_address] [venue_city], [venue_state] [venue_zip]

Phone Number: [provider_phone]

Signature of Authorized Provider Official:

signature

Title: President Date: [registration_date]

Certificate Instructions:
[certificate_content]