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Basic Information

To register for the upcoming CME activity, please fill out the information below.

Adult Mental Health Care Seminar
 
Sunday, June 2, 2019 at 10:00 AM
DoubleTree by Hilton, Monrovia
924 W. Huntington Drive
Monrovia, CA 91016

5.0 AMA PRA Category 1 CreditsTM

CAMASC has implemented an Audience Response System (ARS) as one of the tools to enhance the learning experience and outcome measurement for this activity.  Attendees are required to bring in their cellular phone as the tool to participate in the "Pre/Post-Test” via ARS on-site, and other “Educational Assessment”.
 
Complimentary registration for the first 50 U.S. licensed physicians & physician assistants who register by Thursday, 05/30/19 and are practicing in Southern California. We honor physicians who paid the 2019 CAMASC membership fee with priority registration. 

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* 1. First Name

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* 2. Middle Initial

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* 3. Last Name

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* 4. E-Mail Address

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* 5. Cell Phone
Use this format: ### - ### - ####
Please provide the number of the cell phone you will use for CME Credit.

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* 6. Professional License Number
for CME record

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* 7. Healthcare Role

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* 8. Practice Specialty

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* 9. How did you hear about this activity?

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* 10. Are you a paid 2019 CAMASC member?

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* 11. Will you be attending Brunch Buffet between 10:00AM to 11:30AM?

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* 12. Do you need ADA (Americans with Disabilities) accommodations?
If yes, please call our offices at (213) 572-0631 to inform us of your needs. 

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