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MOE PECK, Ph.D., ATR-BC, LPC, GCP, Mental Excellence Trainer
5617 Adams Avenue, Austin, TX 78756, 512-517-5860

           ATTENDEE NAME: ______________________________________
           LICENSE NUMBER: _________________________

DATE    PRESENTER    TOPIC CONTACT HOURS    INITIALS   
1/7/06 Peck Stress Reduction/Mental Training 9
1/8/06 Peck Ethics 3
2/4/06 Peck Stress Reduction/Mental Training 9
2/5/06 Peck Ethics 3
3/11/06 Peck Stress Reduction/Mental Training 9
3/12/06 Peck Ethics 3
4/1/06 Peck Stress Reduction/Mental Training 9
4/2/06 Peck Ethics 3
5/6/06 Peck Stress Reduction/Mental Training 9
5/7/06 Peck Ethics 3
6/3/06 Peck Stress Reduction/Mental Training 9
6/4/06 Peck Ethics 3
7/8/06 Peck Stress Reduction/Mental Training 9
7/9/06 Peck Ethics 3
8/5/06 Peck Stress Reduction/Mental Training 9
8/6/06 Peck Ethics 3
9/9/06 Peck Stress Reduction/Mental Training 9
9/10/06 Peck Ethics 3
10/7/06 Peck Stress Reduction/Mental Training 9
10/8/06 Peck Ethics 3
11/4/06 Peck Stress Reduction/Mental Training 9
11/5/06 Peck Ethics 3
12/2/06 Peck Stress Reduction/Mental Training 9
12/3/06 Peck Ethics 3
TOTAL HOURS: ___________

The initials of Dr. Peck constitute continuing education credits for these workshops.

___________________________________         ________________________________
MOE PECK                                                          Signature of Attendee

Ph.D., ATR-BC, LPC, GCP, Mental Excellence Trainer
LPC License #13022
Social Work Provider #CS2592
Credits accepted by LMFT and LCDC