Department of Continuing Medical EducationFaculty Profile FormInformation For CME StaffThe following information will be only for CME Staff and Activity Coordinators and will only be used for urgent communication - we will not disclose this information to activity participants or other parties. Your Details Name * Alt. Email Mobile Phone * City * State * -Select-FloridaOutside of the United StatesAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Titles & Credentials Enter the titles, credentials, or affiliations you wish to have displayed in your listing for this activity. (This may be edited/reduced as needed for formatting) A recent Curriculum Vitae is required for faculty participating as speakers. Select how you wish to provide your documents Curriculum Vitae * URL link to file Upload file Upload CV Files must be less than 1 GB.Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx. Link to CV Office Information Add assistant/secretary information? Yes No / NA Assistant Name Assistant Email Phone Number Social Media Permissions Permissions * I give permission to link to my social media profile(s) in promotional posts for this activity. I give permission to mention my name only in promotional posts for this activity. I do not give permission Instagram @ Bluesky @ Facebook @ Course Enrollment Options Select your registration option: * CE/CME Registration (includes MOC) General Registration (course attendance only) All course faculty will be given complimentary registration for this year's course. This year we have two enrollment options available. They are:CE/CME Registration (includes MOC)This course option requires participants to complete each of the day's CME requirements to get credit for their participation. As speaking faculty, your attendance will be marked for the day of your talk and you must complete the CME requirements for any conference day you participate in and wish to claim credits for. Faculty intending to claim MOC credit for the conference must also complete the MOC assessment. Note: The course is accredited for AMA PRA Category 1 Credits™ and MOC ABP Part 2 Credits. Those enrolled for the CE/CME version of the course who cannot claim the designated certified credits, and who complete the course requirements, will receive a certificate of completion commensurate with their time participating in this course approved for AMA PRA Category 1 CreditsTM\ General Registration - Course Attendance ONLYYou will have full access to the course and course content but will not be required to complete any tasks. You will receive a certificate of attendance only with no credit designation. This registration is intended for anyone who wishes to participate in the course but does not need a certificate for credentialing purposes and does not need any credits awarded. Leave this field blank
