Event Notification Form

Outreach Event Notification Form
Use this form to notify communications that you have registered for an event, or that you intend to register for an event
Name*

First NameLast Name
Has this event been approved by your program director?

YesNo
Program Director's email:
example@example.com
Have you registered for this event?

YesNo
Email*
example@example.com
Program*
Name of Event:*
Date you Registered for Event*

MonthDayYear
Date
Please upload Registration Receipt*

If you do not have a receipt, a screenshot of your registration confirmation will work.
Cancelof
Upon registering for this event, please send CME communications a copy of your registration receipt.
Tell us about this event:*
Please provide details of your request here. Please be as specific as possible.
Link to event website/webpage:*
How does this event align with CME's mission?*
What is the purpose of this event?*
How will CME as a whole be represented?*
Please list all goods, supplies, and marketing materials you will need for this event:*
Please check all items you will need:*

TentTablesTableclothChairsNothingOther
Location of Event*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Event:*

MonthDayYear
Date
Do you have staff to man this event?*

YesNo
You must have staff from your program to man this event.
Will other CME programs be attending this event?*

YesNoUnsure
Do you think other CME programs benefit from attending this event?

YesNo
What programs?
Why not?
Will this event be manned/staffed in part or in whole by CME representatives that are not employees? (i.e: CME volunteers)

YesNo
Please elaborate:
Is there anything else we should know?*
Please attach any documents you think Communications should have regarding this event

Cancelof

Outreach Event Notification Form