CPL Event Registration Form

The University of New Mexico School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of New Mexico School of Medicine designates this live activity for a maximum of 2.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Thank you for your interest in this CPL offering. This form has two parts.


Part One requests demographic information and describes any registration fees and payment associated with this event. This page must be completed in order for your registration to be confirmed.


Part Two is optional and requests information which assists CPL in better understanding the reasons for your interest, and in evaluating our program offerings and marketing methods for improvement.


Please answer all questions and click the "Submit" button at the end of the form to ensure a complete registration. Review CPL's General Workshop Requirements here: https://bit.ly/CPLWorkshopRequirements

Effective Feedback and Written Evaluation: Developing Competent Clinicians

Date: Thursday, September 11, 2025


Time: 1:00 - 3:00 pm


Registration Deadline: Friday, August 23, 2025

Blended opportunities include online, self-paced learning completed before a live, in-person session.

As you would like it to appear on your attendance certificate:

As you would like it to appear on your attendance certificate:

As you would like it to appear on your name badge:

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The category that best describes my Position Title is:

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Please enter your department name (e.g., Internal Medicine, Pediatrics). If you are not affiliated with UNM/HSC, type "None."*

(If a UNM/HSC employee, please provide your @Salud or @ UNM address):

Phone

If you are not affiliated with UNM/HSC, please provide the following information:

Registration fees for this event are as follows:

Non/UNM HSC Employee Fee: $180.00

Credit Card or Debit Card


Upon submission of this registration form, you will receive an email with additional workshop information and instructions regarding remitting payment.

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1. Full refunds are available to those providing written or emailed cancelation request up to one week prior to the event date.


2. Refunds less a $40 administration fee will be available to those who provide written or emailed cancellation notice within one week of the event date.


3.No refunds will be provided to those who register but fail to attend, or who cancel their registration on the day of the event.


Acknowledgement of CPL's Refund Policy

I am attending this workshop because:

The workshop material or technology is new or interesting to me.

(1= Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

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The workshop provides training on concepts or skills related to personal goals.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

This workshop has been recommended by a colleague.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

The workshop is required by my department.

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

This workshop fulfills a requirement within the Achievement in Medical Education Program (AMEP).

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

Other motivation not previously listed

(1 = Strongly Disagree, 2 = Disagree, 3 = Neither Agree or Disagree, 4 = Agree, 5 = Strongly Agree)

How did you hear about this event?

(Please check all that apply.)

COVID Precautions

The UNM Health & Health Sciences encourages conference participants to mask indoors. Continuous Professional Learning (CPL), the conference organizers do not conduct contact tracing and advise participants to follow the CDC guidelines for social interaction.


https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

Upon submission of this registration form, you will be notified of the location of the event.

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