CME Program Announcement Request Form

Constituent organizations and PA Programs may submit conference information for the AAPA CME calendar and for posting on the AAPA Web site. If a program has been pre-approved for Category I CME credit, the number of approved hours will be indicated.

Meeting Information for AAPA Web Site and Publications

Dates of meeting

Program title

Provider (Full Name No Acronyms):

Location

Will this program occur within 250 miles and six months (preceding or following) of any of these AAPA Annual PA Conferences? Both qualifiers must apply in order to check the Yes box.

San Antonio, May 24-29, 2008

San Diego, May 23-28, 2009

Yes

No

Meeting Contact Information

Contact:

Phone number

E-mail address

Web address for Meeting

From which of the following organizations will you be applying for CME/CE credit? Check all that apply.

Contact Information for the Submitting Person

This contact information is for internal use only and will not be part of the listing

Name of person submitting the request

E-mail address

Phone number

Educational Grants

Contact AAPA for instructions prior to requesting any educational grants to support this program.

List all commercial organization that may be asked to support this conference:

Applications for conferences are due 4-6 weeks in advance. Information contained on any linked sites may not be in conflict with the mission of AAPA.
If you have any questions, please contact AAPA at 703/836-2272, ext. 3417.

AAPA	AAFP	AMA
AOA	One of the ACCME sponsors	ANCC
ACPE	Other(please specify)