CME Activity Contributor Tracking

CME Activity Contributors

In order to protect the learning environment from industry influence, we ask all those who may control educational content in some way, to disclose any financial relationships they have with ineligible companies.

We will need to track this by collecting the names of all contributors, authors, planners, and editors for this activity.

The ACCME Standards for Integrity and Independence require that we disqualify individuals who refuse to provide this information from involvement in the planning and implementation of accredited continuing education. Thank you for your diligence and assistance.

Lead Organizer (Your Name) *

Your Email Address *

Educational activity is being planned by: (check all that apply)

CalUCA (California Urgent Care Association)
CUCM (College of Urgent Care Medicine)
NERUCA (North East Regional Urgent Care Association)
SERUCA (South East Regional Urgent Care Association)
UCA (Urgent Care Association)

CME Activity *

Is this a new or existing contributor list? *

New
Existing: list needs update with additional contributors

On a Word document or Excel sheet please write a lits of all contributors and include the following information:
Name, Email Address, and Role. Please include all roles of the individual for example planner, speaker, writer, editor.

Contributor List Upload *

Click or drag a file to this area to upload.

Label Columns: Name, Email Address and Role (include all roles of the individual.)

Any additional information you would like to share?

Agreement *

I attest that the above information is correct as of the date of this submission.