1. CME Credit Request Form

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is accredited by the Accreditation Council for Continuing Medical Education (A.C.C.M.E.) to sponsor Continuing Medical Education for physicians.

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) designates this enduring material for a maximum of 9 AMA PRA CATEGORY 1 CREDITS™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

You must pass the FES Test and complete the CME credit request and evaluation forms to obtain CME credits. Please allow 4-6 weeks for delivery of credit letter.

Self-Assessment CME Credit, Part 2 of the American Board of Surgery (ABS) Maintenance of Certification Program: This activity has also been designated as Self-Assessment CME credit, applicable to Part 2 of the ABS MOC program. In order to claim Self-Assessment credit, attendees must complete a passing grade on the FES Test.

NOTE: You should claim only those hours of credit that you actually spent in the educational activity.

Partial credit cannot be granted if you did not pass the FES Test. Full credit is available only upon successful passing of the FES Test.

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* 1. I certify that

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* 2. Name

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* 3. Degree

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* 4. Address Line 1

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* 5. Address Line 2

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* 6. City

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* 7. State

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* 8. Zip Code

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* 9. Country

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* 10. NUMBER OF CREDITS CLAIMED

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* 11. *About your unique identification number - SAGES is required to collect a unique identifier number along with your request for CME credits. The AMA has recently recommended that CME sponsors no longer collect Social Security numbers. The AMA recommends you use your date of birth and your date of graduation from medical school or you may use your FES Test Voucher number.

*Unique Identification number

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