Data form on CME/CPD Credits

Data Form on CME/CPD Credits

Please note that this form will be active only at the end of the academic year 2000/01.

1. Personal Information

First Name:	Middle Name:	Surname:
**	**	**

Registration No.:

Email address: **

Fax No.:

2. CME Credit Hours

The total in Category 2 should not exceed 100. Credit hours acquired during academic year 2000/01 are to be included under 2001/02.

Date : **

** Required

I hereby certify that the above is a true record of the CME/CPD activities undertaken by me.

Please note that you should maintain evidence of your participation in CME/CPD programs for verification.

Please press submit only once.Your application will be processed and a confirmation email will be sent to you.

Press reset to start all over.

Please note that this form will be active only at the end of the academic year 2000/01.