National Clinicians Conference on Medical Aid in Dying

Today's Date (to show your attendance)*
Month
Day
Year
Last Name*
First Name*
Degree (to be listed after your name on the continuing education certificate)*
CME or CE credits requested:*
- MD/DO CME
- Social worker CE
- Nurse CE
- Certificate of completion, no formal continuing education
Email*
State*
By typing your name in this box you affirm that you attended all sessions for the date noted above. (If you did not attend all sessions, use the next box to list the sessions you did attend and request credit for.)*
If you did not attend all sessions for this date, please note below the sessions you attended and are requesting credit for.