Mid-Atlantic MedWAR

Mid-Atlantic MedWAR
CME/CE Credit Application Form

To register to receive CME Credit for participation in the Mid-Atlantic MedWAR Race, please fill out the form below. You will sign it at check-in. Include the type of CME credit you are interested in and your SSN (required). The information will be kept confidential and only used to obtain your CME credit. To obtain CME credit, you must register in advance. You cannot register for CME credit on Race Day.

The physician CME credits will be included in the registration fee, and will not incur a separate charge.

First Name*: Last Name*:

Affiliation: (School/Hospital/Organization/etc.)

Occupation*: If Other:

Type of CME Credit*:

Social Security Number*:

Email*:

Street Address*:
City*: State/Province*:
Country*:
Zipcode*:
Phone Number:

Questions/Concerns