2022 VMAP ECHO enrollment
Questions? Please contact us at projectecho@vmap.org. To learn more about VMAP, visit www.vmap.org
Name
*
First Name
Last Name
Degree(s)
Email
*
example@example.com
Sign me up for VMAP ECHO!
*
VMAP ECHO 101 - 3rd Fridays, 12-1p - Feb to Dec 2022
VMAP ECHO 101 - 4th Fridays, 12-1p - Feb to Dec 2022
Primary Practice Location Name + Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
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District of Columbia
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State
Zip Code
NPI
Specialty
OPTIONAL: Select one option below to register to claim CME credit for your participation. If no CME credit is needed, scroll down to "SUBMIT" your registration.
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CME credits only
Choose this option to receive up to 20 points of CME credit, based upon your participation. CME is available for all provider types.
$
50
QI Project + CME credits
Choose this option to participate in the VMAP ECHO Screening QI Project, which will qualify you for MOC-2 AND MOC-4 credits (up to 60 points).
$
50
Participant Photo (optional)
Or, you can email your headshot at your convenience to projectecho@vmap.org
Pay with PayPal
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Please click one of the PayPal options to complete payment and
submit
the form.
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