Judgement Index Invoice Form- Non Member

Thank you for your interest in taking the Judgment Index™

TMA is pleased to partner with the Judgment Index™ to provide physicians with positive positioning for personal growth, leadership development, and wellness support. This assessment has been used in the Ingram Institute Leadership Lab since 2019 as a professional development tool. Earn up to 2 AMA PRA Category 1 Credits*.

Participant's Full Name*

First NameLast Name

Email *

Please note that all information will be sent to the email address provided.

TMA Member*

YesNo

Region or County Medical Society

City of Practice

Specialty

Please indicate the reason for your interest in the Judgment Index™*

The TMA Judgment Index™ Package Includes

Individual assessment results and summary report
42-page reort of your individual results
One-hour online development course tailored to your identified growth opportunities
Up to 2 AMA PRA Category 1 Credits*

Judgment Index™ Package- Non- Member Price

$314.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

*The Tennessee Medical Association is accredited by the Accreditation Council for Continuing MedicalEducation (ACCME) to provide continuing medical education for physicians. The Tennessee Medical Association designates this enduring material for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The purchase of this course is non-refundable. For additional questions, please email sara.balsom@tnmed.org

Judgment Index™ Non-Member Invoice Form