<p> THE UNIVERSITY OF HONG KONG LI KA SHING FACULTY OF MEDICINE</p><p>Application for Accreditation of CME Activities for Practising Doctors who are not taking CME Programme for Specialists </p><p>Information of applicant:</p><p>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:</p><p>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</p><p>Signature of applicant: Date:</p><p>1 Note</p><p>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</p><p>3. Please state all details of the activities including speakers and topics. Applications without the mentioned information will not be processed.</p><p>4. Please attach the programme of the function with details of session content. Application without sufficient programme details cannot be processed.</p><p>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. </p><p>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.</p><p>7. If no registration fee will be charged, please put “Free” in this column.</p><p>8. The column on CME points will be completed by the Faculty Office. Please leave it blank. * Please delete where inapplicable</p><p>January 2, 2015</p><p>MY/KL/no</p><p>2</p>