We are pleased to include you as a planner for Clinical Academy's upcoming activity. The following are required as soon as possible for our accreditation files and the development of the activity website(s):

  1. Complete and submit the webform below.
  2. Complete and sign a Conflict of Interest Disclosure Form.
    • Click here to download the Faculty Disclosure Form. Do not complete the form in a browser window, download a copy to enable all fields for completion. 

You may upload the requested file(s) by clicking here or by emailing [email protected]. 

AttachmentSize
PDF icon Clinical Academy-Disclosure-Form-Template.pdf215.42 KB
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Example: MD, MPH
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Such as an administrative assistant, or alternate person, you would like included in ongoing communication about your participation at this conference.
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Example: Chief, Division of Transplantation, Hospital Name/Division United Health Group