Application to organize accredited medical meeting

APPLICATION (PHARMACEUTICAL COMPANY):

ADDRESS FIELD

Address Line 1 *

Address Line 2

City *

State *

FAX #

NAME OF MEDICAL REPRESENTATIVE:

DATE OF ACTIVITY

LOCATION OF ACTIVITY *

DURATION OF ACTIVITY (HOURS) *

LOCAL MEETING (JAMAICA ONLY) *

REGIONAL MEETING (CARIBBEAN ETC.) *

TITLE OF PROGRAMMME/ACTIVITY

PROGRAMME CONTENTS

Select File(s)

PROGRAMME GOALS

PROGRAM OBJECTIVES

DESCRIPTION OF EDUCATIONAL METHODOLOGY TO BE USED

METHOD OF PROGRAMME EVALUATION

CREDIT HOURS REQUESTED

NUMBER OF SPEAKERS

NUMBER OF OVERSEAS SPEAKERS

NUMBER OF LOCAL SPEAKERS