Conference Logo, if applicable
CME Activity Title
mm/dd/yyyy – Cityname, ST
ABOUT THIS TEMPLATE: This document is a template for creating a single handout that gives an overview of your
CME activity and includes all CME disclosures that need to be made to learners at your CME activity.
INSTRUCTIONS: Replace all red text below with information about your CME activity. The blue
sentences provide more information and instructions about each CME disclosure. Change all red text
to black (or your desired color) after replacing it with information about your activity, and then
delete all blue sentences before using the template.
Welcome!
Insert your welcome message and activity overview here. The welcome & overview message typically provides
basic information about the topics and how this year’s conference is different from previous years or other conferences
like this one.
Learning Objectives
At the completion of this activity, learners should be able to:
1)
2)
3)
4)
Copy and paste Learning Objective 1 from your CME Credit Application here
Copy and paste Learning Objective 2 from your CME Credit Application here
Copy and paste Learning Objective 3 from your CME Credit Application here
Copy and paste Learning Objective 4 from your CME Credit Application here
Commercial Support
Please see the definition of commercial support to confirm which of your revenues meet the definition of commercial
support. Advertising income and exhibiting income are not considered commercial support.
Thanks to the following for their Commercial Support of this conference:
Organization Name – type of support provided (financial or in-kind), description of support (e.g., educational grant)
Logos Prohibited: The use of logos is prohibited for this disclosure of commercial support. Your disclosure should
be text-only, with no graphics or logos.
If no commercial support was received for this activity, replace the black sentence above with one sentence saying,
“No commercial support was received for this activity” and delete the red sentence.
Thanks to the following for their Advertising support of this activity:
List of Organization Names
If no Advertising income was received for this activity, just delete the 2 black and red sentences above.
Thanks to the following for their Exhibitor support of this activity:
List of Organization Names
If no Exhibitor income was received for this activity, just delete the 2 black and red sentences above.
Credit Information
Paste the Accreditation statement for your activity here. Email the Office of CME at cme@erlanger.org if you have not
already received the Accreditation statement for this activity.
Paste the AMA Credit statement for your activity here. Email the Office of CME at cme@erlanger.org if you have not
already received the AMA Credit statement for this activity.
Paste the Continuing Education for Non-Physicians statement for your activity here. Email the Office of CME at
cme@erlanger.org if you have not already received this statement for this activity.
Planner & Speaker Disclosures
Conference Logo, if applicable
CME Activity Title
mm/dd/yyyy – Cityname, ST
The Office of CME will determine which planners or speakers for this activity have relevant financial relationships, as
outlined in the Conflict of Interest Policy (page 7 of the CME Credit Application).
The following planners & speakers have relevant financial relationships to disclose:
Planner or Speaker Name – nature or description of each financial relationship, Company Name
If no planners or speakers have relevant financial relationships, just change the black sentence above to say “No
planners or speakers have relevant financial relationships to disclose.”, delete the red sentence (above) and delete the
black & red sentences below.
The following planners & speakers have no relevant financial relationships to disclose:
List the Planners’ and Speakers’ Names