ASFA Regional Meeting: CEU/CMLE Credit Request

Thank you for joining us for the 2nd Annual ASFA Regional Meeting!

Please complete this form if you are requesting CEU or CMLE. If you are requesting CME, please email ASFA Head Office at asfa@apheresis.org.

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* 1. Please fill in the information below:

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country: *

Email Address: *

Phone Number: *

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* 2. What is your Academic Degree/Credentials?

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* 3. What is your Medical Speciality (if applicable)?

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* 4. Type of Credit Requested

CEU

CMLE

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* 5. Please list at least 2 changes that you plan to implement in your practice based on what you have learned in this educational activity.

The Perelman School of Medicine at the University of Pennsylvania designates this live activity for a maximum of 7 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity

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* 6. Please indicate the talks that you attended. Please note that continuing education credits are only provided for the talks listed below.

8:30AM- 8:45AM - Welcome - 0.25 Credits

8:45AM - 9:15AM - Primer on Apheresis Medicine (Nicole Aqui, MD, PhD) - 0.50 Credits

9:15AM - 10:15AM - Neurology (Vishesh Chhibber, MD) - 1 Credit

10:45AM - 11:45AM - Solid Organ Transplant (Lee Goldberg, MD, MPH) - 1 Credit

11:45AM - 12:45PM - Erythrocytapheresis in Hematologic Diseases (Haewon Kim, MD) - 1 Credit

1:30PM - 2:30PM - Lipoprotein Apheresis Panel Discussion - 1 Credit

2:30PM - 3:30PM - Use of Photopheresis in a multimodality approach to therapy of Sezary syndrome - 1 Credit

4:00PM - 5:00PM - TUMOR IMMUNITY BY DESIGN – Ex-vivo Modification of Apheresis Derived T Cells for Therapy of Leukemia - 1 Credit

5:00PM - 6:00PM - Renal Apheresis 2013: Indications and Therapeutic Targets (Mark Williams, MD) - 1 Credit

6:00PM - 6:15PM - Activities of ASFA (Bruce Sachais) - 0.25 Credits

Question Title

* 1. Please fill in the information below:

Question Title

* 2. What is your Academic Degree/Credentials?

Question Title

* 3. What is your Medical Speciality (if applicable)?

Question Title

* 4. Type of Credit Requested

Question Title

* 5. Please list at least 2 changes that you plan to implement in your practice based on what you have learned in this educational activity.

Question Title

* 6. Please indicate the talks that you attended. Please note that continuing education credits are only provided for the talks listed below.

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* 7. I certify that my actual time spent to complete this educational activity to be: