APPLICATION FOR CONTINUING MEDICAL EDUCATION (CME) ACCREDITATION Please enable JavaScript in your browser to complete this form.CME MEDICAL ORGANIZER DETAILS:Organization Name *Address: *Tel No.: *Contact Telephone No.: *ACTIVITY DETAILS:Date of Activity: *Location of CME Activity (Hybrid/Virtual/Venue): *Duration of Activity:Co-Organizer Details:• Representative Name: * • Representative Email: *•Representative Telephone No.: *Title of Programme/Activity: *Outline of Day’s Activities (Attach Document): *Programme Goals and Objectives (Attach Document): *EDUCATIONAL METHODOLOGY:Description of Educational Methodology to be Used: *EVALUATION AND ACCREDITATION DETAILS:Method of Programme Evaluation: *Credit Hours Proposed by CME Pharmaceutical/other organization: *SCOPE OF COLLABORATION (Please indicate required services by checking the appropriate box): Accreditation Support IT Support for Hybrid or Virtual Events Distribution of CME Certificates Designing of Promotional Flyers Provision of Zoom Platform Advertising and Promotion of Event Design of CME Certificate Provision of Post-Event Report (Attendee Report & Copies of CME Certificates) SUBMISSION OF REQUIRED DOCUMENTS: Partners must submit the following documents to facilitate the application process: Event Agenda Speaker Bios Programme Objectives Other Supporting Documents as Necessary AUTHORIZATION: I, the undersigned, confirm that the information provided is accurate and that the required documents will be submitted as part of this application.Upload Documents * Click or drag a file to this area to upload. Name of CME Medical Organizer Representative: *Date: *Submit