CME Forms

CME Forms (For use by GBMC-Affiliated Physicians and Staff)

The following forms are available for you online or you may contact the CME office at 443-849-3670 or lwagerma@gbmc.org to have the forms mailed or faxed to you.

Category 1 CME Application

Category 1 CME Application for Regularly Scheduled ConferencesUse this form to apply for credit for grand rounds, tumor boards, etc.

Speaker Letter and Information FormThis is a 2 part-document.  The first page is the speaker letter and the second page is the speaker form.  This form is for use when confirming a speaker's time and topic.  It is to be used as a follow-up after speaker has been confirmed verbally.

W-9 Form
This form must be completed by speaker before any honorarium can be paid

W-9 Form Instructions

Faculty Disclosure of Relevant Financial RelationshipsThis form is to be completed by each speaker at a CME activity.  It must be signed and returned to the CME office prior to the program date.

Letter of Agreement
This form is to be completed when a CME activity is receiving an unrestricted educational grant from an outside company.  It must be signed by a company representative and the program director and then returned to the CME office.   

Resolution of Personal Conflict of Interest
This form is to be completed by all members of the planning committee and submitted along with the CME application.

 
 

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