2015 WSMA CME Credit Claim Form Template Survey

To claim CME credit, please provide your contact information below. (Required.)

Full Name:

Credentials:

Address:

City/Town:

State:

ZIP:

Country:

Email Address:

Company:

The grid below shows the number of credits available for each agenda item. Please tally the number of credits you are claiming, and enter the amount in the box below.

Credits Available
1	Sept. 26 - 2 p.m.	KEYNOTE: The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care – T.R. Reid
1	Total Credits

Physicians: The number of credits claimed equals the number of AMA PRA Category 1 Credits™ awarded, with one hour of participation equaling one AMA PRA Category 1 Credit™. Physicians should claim credit in 15 minute (i.e. 0.25 credit) increments.This live activity was designated for 1 AMA PRA Category 1 Credits™.

All other attendees: Please complete this form so that we may verify your participation in this activity, which was designated for 1 AMA PRA Category 1 Credits™.

Attestation & Credits Claimed(Required.)

I attest that I attended CME sessions at the 2015 WSMA Annual Meeting on September 26-27, 2014.

Number of credits claimed (up to 1):