Thank you for your interest in presenting at an upcoming North Carolina Academy of Family Physicians (NCAFP) CME meeting. Our educational programs primarily focus on clinical content and topics directly relevant to Family Medicine. We also welcome proposals related to medical education, practice management, coding, quality improvement, AI use in medicine, and other topics that support family physicians in their day-to-day work.

Please complete the brief questionnaire below to help us better understand your background and areas of expertise. Submission does not guarantee selection, but all responses are reviewed by the CME team and program chairs.

Sincerely,
Kathryn Atkinson, CMP
Director of NCAFP CME & Events
Katkinson@ncafp.com

*1.Please provide your Full Name and Professional Designation (MD, DO, PA, NP, other)(Required.)

*2.Organization / Company /Employer(Required.)

*3.Current Professional Title / Role(Required.)

*4.Email Address(Required.)

*5.Phone Number(Required.)

*6.Are you a current NCAFP/AAFP Member?(Required.)

Yes

No

*7.Please list the topic areas you are most interested in presenting on.(Required.)

*8.Briefly describe the focus of each of the topics indicated above.(Required.)

*9.Have you presented CME content before?(Required.)

Yes

No

*10.If yes - when and where have you presented before? (Enter N/A if you have never presented CME content before.)(Required.)

*11.Please provide the name & contact information of at least one professional reference or recommendation. (This may be a colleague, department chair, program director, or prior CME organizer.)(Required.)

*12.Are there any potential conflicts of interest we should be aware of? If so, briefly explain.(Required.)

13.Is there anything else you would like the CME planning committee to know about you or your topic(s) of interest?