Boot Camp PDH Form Please use this form to submit for pdh credits. Certificate will be emailed upon verification. Name First Last Company Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone (xxx-xxx-xxxx)Email* Please check if needed for New York or Florida License Will be used for New York State Continuing Ed Requirements (Signature on Session Verification Form Required) Will be used for Florida State Continuing Ed Requirements Florida State License # Please check all sessions attended. Continuing Education Credit Certificates are awarded according to your response, the registration records, and the sessions approved for credits. "Early Bird" Sessions (7:30-8:00 AM) EB1: Engineering Ethics EB2: Evaluating the Air Quality Benefits of the Healthy Ride EB3: Ecological Considerations for Site Development Projects Transportation Track TR1: A New Bridge Over The Oregon Inlet, Outer Banks (8:00-9:00 AM) TR2: Phased Replacement of Two-Span Closed Spandrel Concrete Arch Bridge (9:00-10:00 AM) TR3: Bridge Management and Maintenance (10:00-11:00 AM) TR4: South 10th Street Bridge Rehab (11:00-12:00 PM) Water Track W1: Inspection To Insight: Robotic Condition Insight (8:00-9:00 AM) W2: Linings, Wet Well & Manholes (9:00-10:00 AM) W3: Green Infrastructure Opportunities and Challenges (10:00-11:00 AM) W4: Breaking Down PFAS as an Emerging Contaminant (11:00-12:00 PM) Industrial Track G1: Pump System Reliability (8:00-9:00 AM) G2: High Performance Maintenance Coatings (9:00-10:00 AM) G3: Lessons Learned in Engineering (10:00-11:00 AM) G4: Environmental Concerns and Project Engineering (11:00-12:00 PM) Lunchtime Plenary Session Volunteering and Problem Solving Around the World Transportation Track TR5: Transportation Analysis Tools which to Choose (1:30-2:30 PM) TR6: In-Depth Finite Element Analysis.. 7th Street (2:30-3:30 PM) TR7: Connected Vehicles 101 (3:30-4:30 PM) Technology Track T1: Emerging Technologies in Engineering and Construction (1:30-2:30 PM) T2: How to "Break" your Data and Iron Out those Stair-Steps (2:30-3:30 PM) T3: Cybersecurity (3:30-4:30 PM) Legal & Ethics Track L1: Sex Discrimination in the Engineering Workplace (1:30-2:30 PM) L2: It's a Matter of Ethics (2:30-3:30 PM) L3: PA Separations Act (3:30-4:30 PM) Additional CommentsRequired Statement* I certify that I have attended/participated in the above qualifying activities to be applied towards Professional Development Hours (PDH) credit issued through the Engineers’ Society of Western Pennsylvania for my attendance at the 2019 PDH Boot Camp.