Registration Form

ACFAS Residency Director Forum, Los Angeles, CA*
LA Convention Center, Room TBA
 
Wednesday, February 8, 2023
4:30 – 6:30pm             Program Director Workshop
6:30 – 7:30pm             Evaluator Training

*Please register with CPME if you plan to stay for the residency evaluator training, even if you are already registered with ACFAS, so we know how much dinner to provide. Dinner is provided only for those staying for the final session. 
• If you are attending the ACFAS training and do not plan to register with ACFAS for the program director workshop, please email CPME so we can provide you with the necessary room information and ensure you are allowed into the CPME-portion of the program director forum.

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* 1. Your name:

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* 2. Your email address:

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* 3. Your program name:

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* 4. Program type (select all that apply)

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* 5. Your current role in the program

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* 6. Are you a current on-site evaluator?
(Please Note: On-site evaluators must attend one full training workshop in order to continue to serve as active evaluators.)

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* 7. If you're a trained evaluator, which roles are you approved for? (Select all that apply)

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* 8. If you are not a trained evaluator, are you interested in becoming one?
(Please Note: ABFAS/ABPM has to approve all evaluator applications, see more information here.)

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* 9. Are you participating in the evaluator training?
(You don't need to be trained or approved evaluator candidate to attend this portion of the training. Attending this potion will provide insight into the evaluation process.)

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* 10. Do you want a vegetarian meal? (Unfortunately, we are unable to provide vegan options.)

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