Satellite CME Symposium Application

AAFP FMX | October 13-17, 2020 | Chicago, IL

Providers planning to hold a Satellite CME Symposium must complete this application in its entirety. By signing this application provider agrees to adhere to AAFP Guidelines for Satellite CME Symposiums.

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Activity Title 


CME Provider

Enter exact name of the organization (e.g., hospital, university, etc.) responsible for the overall event.

Organization Name

Contact Name

Address

City

State

ZIP

Phone number

Email address


Event sponsor(s)

Enter exact name/organization/company as it should be acknowledged in contractual and print material.


Secondary sponsor(s)

Enter exact name/company as it should be acknowledged in contractual and print material.


Event time(s)

Please indicate below your first and second choice of an event time. 

First choice: 

Second choice:


Form submitted by:

Name

Email address