HOME STUDY CME ENROLLMENT FORM

The Journal of Urology® HOME STUDY CME ENROLLMENT FORMProgram Description and Objective: The Journal of Urology® Home Study Course is a comprehensive learning activitydeveloped by a team of educators, academicians, and clinicians. After completing the program, urologists will be able to demonstratean increase in or affirmation of their knowledge of clinical medicine. They will also be able to evaluate the appropriateness of clinicaldata and apply it to their practice and to the provision of patient care.

Program Format: To receive Category 1 CME Credit hours for The Journal of Urology ® Home Study, submit The Journal ofUrology ® Home Study CME Enrollment Form with payment of $60.00. Once AUA receives your Journal of Urology Home StudyCME Enrollment Form and payment, answer sheets are mailed to you. Five articles are selected by the editor to be read in eachissue. Answer five questions on the answer sheet. Return completed answer sheets in the provided envelope. Completion of each testand a score of 80% or more qualify for 2 hours Category 1 CME Credit hours.

Accreditation: The American Urological Association Education and Research, Inc. is accredited by the Accreditation Council forContinuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians. The American UrologicalAssociation Education and Research, Inc. takes responsibility for the content, quality, and scientific integrity of the CME activity.

CME Credit: The American Urological Association Education and Research, Inc. designates this educational activity for amaximum of 24 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those creditsthat he/she actually spent in the educational activity.

See page 1917 for questionnaire

The Journal of Urology® Home Study Program Registration Form

Volume #

$60 subscription cost covers two consecutive volumes beginning with Vol. 171Volume # 24 Category 1 credit hours

Name:

Address:

City: State: Zip:

Daytime Phone: ( )

( ) Check enclosed for $ payable to: American Urological Association Education and Research, Inc.®

Charge to ( ) VISA ( ) MasterCard ( ) AMEX

Card Number: Exp. Date:

Signature:

Please mail or fax registration form to: American Urological Association Education and Research, Inc.®

1000 Corporate Blvd.Linthicum, MD 21090Telephone: 1-410-689-3934Fax: 1-410-689-3937

1916

HOME STUDY CME ENROLLMENT FORM

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