2025 APGO FDS CME Form

Instructions:
1. Enter ALL information requested in the fields below.
2. Indicate the appropriate sessions attended and enter the total number of credits.
3. Sign your name and date the CME form.
4. Click Submit.
Participant Information:
Name*
First Middle Last
Suffix (MD, DO, etc.)*
Suffix
Medical License Number
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Credit Claim:
Total CME Credit for Sunday (01/12/2025)*
(Maximum 4.5 hours - Plenary, Workshop 1 & 2)
Total CME Credit for Monday (01/13/2025)*
(Maximum 4.5 hours - President’s Plenary, Plenary, Round Tables, Workshop 3)
Total CME Credit for Tuesday (01/14/2025)*
(Maximum 3.25 hours - Plenary, Workshop 4 & 5)
Total CME Credit*
Digital Signature*
I certify that the above information is correct and documents only those credits that I actually spent in the activity.
Date*
MM slash DD slash YYYY
Note: It typically takes MECCOP 6-8 weeks to complete the CME process. Duplicate certificates will incur a $25.00 fee each. You can send a copy of your Certificate of Attendance to the ACOG CME Department for tracking.

Participant Information: