CME Activities to Be Held During the Period October 2001 March 2002

THE UNIVERSITY OF HONG KONG LI KA SHING FACULTY OF MEDICINE

Application for Accreditation of CME Activities for Practising Doctors who are not taking CME Programme for Specialists

Information of applicant:

Name of Organizer (Faculty/Department/Centre/Institute within HKU1): Address of Organizer: Other Organizer(s) [if applicable]: Name of applicant: Prof/Dr/Mr/Miss/Ms/Mrs* Contact person for this application [if different from the applicant]: Prof/Dr/Mr/Miss/Ms/Mrs* Contact Tel No.: Fax No.: Email:

Details on CME activity: Enquiry For Maximum CME Registration Date/Time2 Venue Title of Function3,4,5 Speaker(s)3 (Contact Person & official use: Capacity Hours6 Fee7 Tel/Fax/E-mail) CME Points8

Signature of applicant: Date:

1 Note

1. The Committee on CME Programme for Non-specialists of the Li Ka Shing Faculty of Medicine, The University of Hong Kong may only accredit relevant CME activities organized by a unit within this University. Please submit the duly signed application form to the Faculty Office at 6/F, William MW Mong Building, 21 Sassoon Road. 2. Please use the following format for consistency: dd/mm/yy ?:00 - ?:00 am/pm, eg 10/12/2001 9:00 - 11:00 am

3. Please state all details of the activities including speakers and topics. Applications without the mentioned information will not be processed.

4. Please attach the programme of the function with details of session content. Application without sufficient programme details cannot be processed.

5. Please submit the content of each lecture of a structured programme for the Committee’s vetting. Only lectures which are of educational value to medical doctors will be granted CME points.

6. For CME hours, time for registration, opening ceremony, lunch, dinner and tea/coffee break, etc (which are supposed to be of no educational value) should be excluded.

7. If no registration fee will be charged, please put “Free” in this column.

8. The column on CME points will be completed by the Faculty Office. Please leave it blank. * Please delete where inapplicable

January 2, 2015

MY/KL/no