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ATTORNEY AFFIRMATION

NEW YORK CLE CREDIT FOR NONTRADITIONAL FORMAT COURSE

I,

,acknowledge receipt of the course materials for:

I certify that I have listened to and/or viewed the above course in its entirety. Therefore, I request that I
be awarded the applicable number of New York CLE credits for this course.

Format (check one)

CDDVDOn Demand

Member (check one)

NCBA MemberNon-Member

During the course or program you will see and/or hear a CLE code(s). Please enter the code(s) in the
above field. If you do not include the code(s), you will not be awarded New York CLE credit. Please call
516.747.4464 if any questions

To obtain New York CLE credit, please complete and sign this form and then submit it to the above CLE provider. Once your participation is verified by the provider, a New York CLE Certificate of Attendance will be issued to you by the provider. • New York attorneys should retain a copy of this affirmation along with their New York CLE Certificate of Attendance. • Please note that in New York, one hour of CLE credit consists of at least 50 minutes of instruction. Credit hours must be calculated in no less than 25-minute (.5-hour) increments.