Internal use
HKCPath Ref.:
HKAM Ref.:
Fellows of Hong Kong College of Pathologists
CME/CPD Program Attendance Record for
Participation as an Attendee (PP)
Program Name:
Date / Time:
Venue:
Duration in Hours:
Organizer:
Contact Person:
Tel:
Fax:
Email:
1 CME/CPD points per hour excluding breaks
Max. CME/CPD points _____ (if any)
CME Points
Accredited:
Name
(in block letters)
Name
Signature
(in block letters)
1.
17.
2.
18.
3.
19.
4.
20.
5.
21.
6.
22.
7.
23.
8.
24.
9.
25.
10.
26.
11.
27.
12.
28.
13.
29.
14.
30.
15.
31.
16.
32.
Signature
(Note: No CME/CPD points for PP will be awarded for the part of FCAA where CME/CPD points for Active Participation have been awarded)
Please return to:
The College Secretary
The Hong Kong College of Pathologists
Room 606, HKAM Jockey Club Building
99 Wong Chuk Hang Road, Aberdeen, Hong Kong
Tel: 2871 8756
Fax: 2871 8755
Attendance_Participation as Attendee (PP) – revised Jan 2011
Signature / Official Chop of Organiser