• Are you a medical practitioner?
  • Are you a full time active medical practitioner for a minimum period of one year immediately preceding the date of application?*
  • How many years have you been actively practicing?*
  • What category do you fall into?*
  • Which describes your practice location?*
  • Do you have referring doctors who send their patients to your practice?*
  • Do you refer your patients to other doctors you trust?*
  • Are you a member / interested in becoming a member of a CME Organization?*
  • Have you participated in an awards program before?*

  • Thank you for your time.

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