1 Start 2 Complete CME Activity Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20242025202620272028 Planning Organization/Department Type of Providership Joint-Providership (Non-accredited requester) Direct Providership (Banner system) FEES - All fees are due upon approval of credit. Joint-Providerships Select all that apply. Administrative fee (applies to Jointly provided activities). Processing application to submit for review: $350 Single Activities (conferences, symposia, and webinars). In addition to Administrative fee: $100 per credit hour Regularly Scheduled Series (RSS) Live and/or virtual. Up to 12 sessions/annually. 1-2 credits. Due annually upon renewal of credit: $900 Enduring Materials, On-demand (Joint-providerships). Up to 2 hours. Each hour over 2 hours $50 each: $900 Rush fee. Activities up to 4 hours and less than 30 days in advance: $350 Rush fee. Activities more than 4 hours and less than 45 days in advance: $500 Direct-Banner Activities Select all that apply. Single Activities (conferences, symposia, and webinars): $100 per credit hour Regularly Scheduled Series (RSS) Live and/or virtual. No charge. Enduring Materials, On-demand. No charge. Rush fee. Activities up to 4 hours and less than 30 days in advance: $250 Rush fee. Activities more than 4 hours and less than 45 days in advance: $400 Other... Direct-Banner Activities Other... Total Fees: SERVICES Provided by the CME OfficeStandard services:Facilitation of application to obtain approval of physician credit AMA PRA Category 1 Credit™Ongoing consultation to ensure compliance with regulations for AMA PRA Category 1 Credit™Maintenance of attendance records for six yearsProvision of reports verifying attendance at single sessions, conferencesProvision of transcripts summarizing credits acquired (Physicians, APPs) Leave this field blank
