Grand Rounds Sign In Sheet

Your Check In Time is defined after you hit the Submit button. Check In Time is open 15 minutes prior to event and until 20 minutes after event starts.

If you Check In after the initial 20 minutes you are considered late sign in and no credit is awarded.

Name


A red asterisk (*) indicates required questions.


  1. Name of the Program you are Attending Online.*
    Pancreatic Cancer
    Diabetes Update
    Hypotrophic Cardiomyopathy
    Celiac Disease


  1. Your Title (ex. MD, DO, NP, PA, RN, etc).*
    MD
    DO
    PA
    NP
    RN
    OTHER


  1. Type of Credit you require.*
    CME
    CEU
    Not Appicable
    Other


  1. If you are board certified in ABIM, ABP or ABA. Would you like your credit submitted to your board?
    Yes
    No


  1. If Yes, please type your Board Certificate Number and your Birthday and Month (example: 02/23)




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