Meeting Request Form – Individual Meeting

Enrollment Type *
Local SocietyHospital
Meeting Type *
New meeting for approvalMeeting Cancellation NoticeChanges to previously approved meeting
Name of Organization
Contact Person
Email
Meeting Information
Title of Proposed Meeting *
Date of Proposed Meeting *
Location of Meeting (Place, City, State) *
Length of Meeting *
Number of CEU Hours Requested *
Speaker(s) *
Please provide a brief overview of the content to be covered during this meeting. *
Please list one learning objective for each hour of proposed content. *
Meeting format *
Didactic lectureCase-based presentationsInteractive (echo jeopardy, etc.)Other
Submission and Signature
Please upload a copy of your meeting agenda.
Please upload a copy of your meeting flier for approval (if separate from your agenda)
Electronic Signature
Please use your full name. By signing here you are agreeing to comply with all CEU Program Guidelines. *