"NO FEE" LIVE CME COURSE PRE-APPLICATION PROPOSAL/SURVEY

Contact Info

Name

Department

Email Address

Phone Number

1. Event Activity Title

2. Date of Activity This question requires a valid date format of MM/DD/YYYY.

calendar

3. Agenda

4. Objectives (List at least 3)

5. Audience (list of professionals)

7. What monetary sources or support do you have for this event?

8. Do you have commercial support or support from exhibitors?

9. Is this a new event?

10. Have you had a “No Fee” event granted in the past 3 years?

11. If Yes, which event did you receive this for?

11. How many of these “No Fee” events have been grants to your division in the past 3 years?

11. Please list these events and their attendance in the table.

11. If you held this event in the past 5 years, how many attended that event?