Application for Accreditation of Continuing Education Courses and/or Events in Podiatric Medicine. — Canadian Council on Podiatric Medical Education

All applications should be submitted six (6) to eight (8) weeks prior to an event.

Name of Event

Start date of proposed event

YYYY

End date of proposed event

YYYY

Address of event

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Title or subject(s) being presented

Course objectives

Please be as specific as possible

Target audience

Podiatrists, Medical doctors, Nurses, etc..

Presenters

Include professional designations

Name 1

First Name

Last Name

Name 2

First Name

Last Name

Name 3

First Name

Last Name

Name 4

First Name

Last Name

Name 5

First Name

Last Name

Name 6

First Name

Last Name

Name 7

First Name

Last Name

Name 8

First Name

Last Name

Name 9

First Name

Last Name

Name 10

First Name

Last Name

List additional presenters names & professional designations, if necessary

How many credit hours being applied for (1 hour presentation = 1 CME credit)

Course Director

The course director should be either a doctor of podiatric medicine (DPM) or a medical doctor (MD). Other course directors (i.e. Ph.D., C. Ped, etc…) will be considered on an individual basis.

First Name

Last Name

Email Address

Company / Corporate Name

Company / Corporate contact person

Email Address

Phone

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