CME Credit Form Please fill out and return to the registration counter in registration area at the conclusion of the conference. Or return to the Northeastern Section Administrative Offices at 1000 Corporate Blvd. Linthicum, MD 21090 or fax to 410-689-3837. Only mark those courses you attend. Your CME certificates will be mailed to the address provided below. AUA ID# ____________________ LAST NAME CREDENTIALS FIRST NAME ADDRESS CITY STATE/PROVINCE COUNTRY ZIP/POSTAL CODE Accreditation The American Urological Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The American Urological Association takes responsibility for the content, quality and scientific integrity of this CME activity. CME Credits The American Urological Association designates this educational activity for a maximum of 18.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity Thursday 7:45 – 8:40 a.m. 8:40 – 9:45 a.m. 10:15 a.m.– Noon 10:15 a.m.– Noon 1:30 – 2 p.m. 2 – 2.45 p.m. 3:15 – 5 p.m. 3:15 – 5 p.m. ____ (1.00 credits) ____ (1.00 credits) ____ (1.75 credits) ____ (1.75 credits) ____ (0.50 credits) ____ (0.75 credits) ____ (1.75 credits) ____ (1.75 credits) Plenary I: Erectile Dysfunction (ED) After Radical Prostatectomy Plenary I: Locally Advanced and Metastatic RRC Moderated Poster Session I: Prostate Cancer Moderated Poster Session II: Basic Research Plenary II: Testosterone Supplementation & Its Risks Plenary II: Prostatitis: A Phoenix Rising Moderated Poster Session III: Robotics, Endoscopy & Laparoscopy Moderated Poster Session IV: Bladder Cancer Thursday Total ____ (6.75 possible) Friday 7:30 – 7:45 a.m. 7:45 – 8:45 a.m. 8:45 – 9:45 a.m. 9:15 – 9:45 a.m. 10:15 a.m.– Noon 10:15 a.m.– Noon 1:15 – 2:15 p.m. 2:15 – 3:15 p.m. 3:30 – 5 p.m. 3:30 – 5 p.m. Best of Poster Session Plenary III: Section Stars Plenary IV: PSA Screening State-of-the-Art Lecture 6: New Surgical Concepts for Male Infertility Moderated Poster Session V: Pediatric Urology Moderated Poster Session VI: Oncology Plenary V: Prostate Cancer Chemoprevention Plenary VI: AUA Course of Choice: Interstitial Cystitis/Painful Bladder Syndrome and Related Conditions: Practical Management Strategies Moderated Poster Session VII: General Urology Moderated Poster Session VIII: Kidney Cancer ____ (0.25 credits) ____ (1.00 credits) ____ (1.00 credits) ____ (0.50 credits) ____ (1.75 credits) ____ (1.75 credits) ____ (1.00 credits) ____ (1.00 credits) ____ (1.50 credits) ____ (1.50 credits) Friday Total ____ (8.00 possible) Saturday 7:30 – 8:30 a.m. 8:30 – 8:45 a.m. 8:45 – 9:30 a.m. 9:30 – 10:15 a.m. 10:45 – 11:20 a.m. 11:20 a.m.– Noon Residents Breakfast Program Best of Poster Session George F. Slotkin Lecture: Sun, Light and Shadows Plenary VI: Androgen Deprivation Therapy Plenary VII: Urinary Obstruction from the Cradle to the Grave Plenary VII: Stress Urinary Incontinence and Unstable Bladder ____ (1.00 credits) ____ (0.25 credits) ____ (0.75 credits) ____ (0.75 credits) ____ (0.50 credits) ____ (0.75 credits) Saturday Total ____ (4.00 possible) _____________________________________ Signature OVERALL TOTAL HOURS ____ (Total Possible Credits 18.75)