General Information Name Email address Phone number Today's Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Choose one of the following: New activity request Update existing activity request Conflict of Interest disclosure review request Activity Type RSS Annual Activity/Course Enduring Material Other RSS Activity Name Changes to be made: Create new activity Update current activity Create new sessions Delete sessions Modify sessions Describe requested changes Annual Activity/Course Activity Name Changes to be made Create new activity Update current activity - non-website changes Update current activity - website changes Request information about current activity Describe requested changes Enduring Material Activity Name Changes to be made: Create new activity Update current activity - non-website changes Update current activity - website changes Request information about current activity Describe requested changes Other Activity Name Changes to be made: Create new activity Update existing activity Request information about current activity Describe requested changes Conflict of interest Disclosure Requests Name of individual needing Conflict of Interest Disclosure review Email address Name of individual needing Conflict of Interest Disclosure review Email address Name of individual needing Conflict of Interest Disclosure review Email address Name of individual needing Conflict of Interest Disclosure review Email address Name of individual needing Conflict of Interest Disclosure review Email address Completion Notifications Preferred method for notification of completion Email Phone call No notification needed Requested completion date "Request for Activities" submissions will be handled in the order in which their are received. The CME Team will do their best to honor all updates by the requested date, however, due to staffing limitations, updates may take longer than the requested time. Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Leave this field blank
