AAOS Joint Providership Initial Request

AAOS CME Joint Providership

Initial Request Form
INITIAL REQUEST
Date of Request:
Organization Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person

First NameLast Name
Email Address
Telephone

Area CodePhone Number
Joint Providership is requested for the following CME activity:
Type of Activity

Other
Activity Title
Start Date
End Date
Location (City/State) -if applicable
Program Chair/ Editor

First NameLast Name
You are responsible for obtaining current financial disclosure information from the planning committee, staff, faculty, and anyone contributing/participating in the CME activity using the AAOS Disclosure Database. Disclosure information must be current within the 24 months preceding the start of the CME activity of {startDate}.
Please upload disclosures for all Planning Committee/Staff

Browse Files

Cancelof
Please upload disclosures for all faculty

Browse Files

Cancelof
Please upload all Preliminary Program/Agenda documents

Browse Files

Cancelof
BY CLICKING SUBMIT:
- I attest that this organization is not an ineligible company as defined by the Accreditation Council for Continuing Medical Education (ACCME). Please visit the ACCME website to review the ineligible company definition.
- I attest that any owners and/or employees of an ineligible company have been excluded as planners and/or faculty and will not be allowed to influence or control any aspect of the planning, delivery, or evaluation of accredited continuing education, except in the limited circumstances outline in Standard 3.2. Please visit the ACCME website to review Standard 3.2
Please note that AAOS will review this information in accordance with the ACCME Standards to make the final determination of eligibility and respond within ten business days.
AAOS WILL NOT BEGIN TO REVIEW ACTIVITIES UNTIL ALL RELEVANT INFORMATION IS COLLECTED
Thank you!
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AAOS CME Joint Providership