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

Other
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?
You must have staff from your program to man this event.
Will other CME programs be attending this event?
Do you think other CME programs benefit from attending this event?
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)
Please elaborate:
Is there anything else we should know?
Please attach any documents you think Communications should have regarding this event

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Outreach Event Notification Form