2023 Winter CME Attestation Form

2023 Winter CME Seminar Attestation Form

January 20-22, 2023
At its July 2003 meeting, the AOA Board of Trustees adopted a policy on “On-Site Monitoring for Continuing Medical Education Programs.” The policy requires that accredited AOA CME sponsors obtain a signed attendance sheet from each attendee indicating the number of hours actually attended for each sponsored CME activity. This policy will be implemented starting with the new CME cycle January 1, 2004.

CME attendees are only to report the number of hours that the physician certified/attested that he/she attended.

Please complete the following to insure the proper reporting of your CME hours to the American Osteopathic Association:

This event is approved for 17 AOA Category 1-A credits. You should only indicate the number of hours you attended.
Name:*

First NameMiddle NameLast Name
Date*

MonthDayYear
Date
Email:*
example@example.com
Number of hours:*
(Note: Reporting closes February 17, 2023. All forms must be turned in by this date)
Would you be interested in becoming a speaker?

YesNo
Should be Empty:

2023 Winter CME Seminar Attestation Form