1 Start 2 Complete After submitting the worksheet below, a representative from our office will contact you to explore the idea further. Thanks for your interest in CECentral! Activity Director * Enter your first and last name. Phone Number * Please enter a valid phone number. Email * [email protected] Affiliation * Funding Source * Activity Details * Target Reach * Please select one. - Select -Internal OnlyLocalRegionalNationalInternational Will this activity offer education for 2 or more professions? * Yes No Target Audience * Physician Pharmacist Nurse Social Worker Public Health Professional Student Other Target Audience Other Activity Format * In-Person Live Internet Enduring Material Number of Speakers * Why is this education needed? * What would the training change in the participants' skills/strategy, or performance or patient outcomes? * What outcomes would result from the above changes in skills/strategy, or performance or patient outcomes? * Estimated Date of Activity * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20232024202520262027 CECentral Contact Leave this field blank
