1. CME Application Form

Application Form

The Innovative Healthcare Institute (IHCI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. IHCI has the ability to provide AMA PRA Category 1 Credit™ to non-accredited entities hosting non-commercial, physician-based educational events.

Please complete this form. Upon receipt, your submission will be reviewed, and if approved, you will be provided with an IHCI CME Joint Providership Activity Planning Form. A non-refundable administrative fee of $250.00 plus an online processing fee of 3% + $0.30 will be invoiced once the agreement has been signed. The application, administration and first credit hour fees must be submitted at least 90 days prior to the scheduled activity.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Are you applying as an individual or on behalf of an organization?

IndividualOrganization
Organization Name (if applicable)
Organization Address
Does your organization meet any of the following criteria? (Check all that apply)

Produce products used by or on patientsMarket products used by or on patientsSell or resell products used by or on patientsDistribute products used by or on patientsNone of the above apply
Is this activity being jointly provided with another organization?

NoYes

Please see the fee schedule below. Most activities range from $3,600 - $15,000 per activity.
Upon approval of your application, payment of the application fee, joint providership administration fee, and the first credit hour fee—totaling $1,500.00—will be required. Please indicate your preferred method of payment.*

Electronically (a processing fee of 3% + $0.30 will be added)Mail in paymentOther
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