2021 Initial Request

AAOS CME Joint Providership

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

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Person *

First Name Last Name
Email Address *
Telephone *

Area Code Phone Number
Joint Providership is requested for the following CME activity:
Type of Activity *

Live Course/meeting
Activity Title *
Start Date *
End Date *
Location (City/State) -if applicable
Program Chair/ Editor *

First Name Last Name
You are responsible for obtaining current financial disclosure information from the Planning Committee & Staff involved in the education planning process using the AAOS Disclosure Database. Planning Committee/staff disclosure information must be current within the 12 months preceding the start of the CME activity of {startDate}.
Planning Committee (please list) *
Please upload disclosures for all Planning Committee/Staff *

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Please upload all Preliminary Program/Agenda documents *

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Thank you!
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AAOS CME Joint Providership