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2026 AOASM Clinical Conference: CME and CE Reporting Form
Please complete this survey by indicating the sessions attended.
Surveys must be submitted on or before June 1, 2026.
AOASM is not responsible for surveys returned after the due date!
*
1.
First Name:
(Required.)
2.
Middle Initial:
*
3.
Last Name:
(Required.)
*
4.
AOA Number
(if you are not seeking AOA Category 1-A credits, please put "N/A" in the answer box and proceed to the next question.
(Required.)
5.
If you are seeking other continuing education credits (not AOA), please indicate the type below:
ATC (BOC credit)
PT
PTA
Other (please specify)
Please note that ATCs, PTs, PTAs, etc., must self-report continuing education hours to their respective boards. Please check with your licensing board for the proper reporting procedures.
*
6.
Email Address:
(Required.)
*
7.
Daytime Phone:
(Required.)
8.
I would like to receive Continuing Medical Education (CME)
specialty credit hours
for my specialty, if applicable. I understand that I must provide all my specialties on this form in order for those specialty hours to be formally reported to the AOA.
My Board Specialties are:
Specialty 1:
Specialty 2:
Specialty 3:
*
9.
Were you a conference SPEAKER and are eligible for CME credit hours?
(Required.)
Yes
No
If yes, date and time of your lecture(s)
*
10.
Were you a PODIUM PRESENTER and are eligible for CME credit hours?
(Required.)
Yes
No
If yes, date and time of your lecture(s):
*
11.
Did you participate as a JUDGE and are eligible for CME credit hours?
(Required.)
Yes
No
If yes, date and time of your lecture(s)
