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Addiction Performance Project, CME Credits Available

NIDA Addiction Performance Project Registration:

Select an event from the options below. Please note that some events require registration on the host’s Web site. Additional performances will be added, so please check back or sign up for alerts from NIDAMED.

*Event Name:

*Are you a registered conference attendee?
YesNoNot Applicable

*First Name:

*Last Name:

*Education (Check all that apply):
MD
DO
DDS
Doctorate (PhD, EdD, PsyD, DSW)
Master's Degree (e.g., MS, MA, MSW, LCSW, MRN)
NP, RN, LPN, PA
Other, (please specify):

*Profession (Check all that apply):
Physician
Resident
Medical Student
Nurse Practitioner
Physicians Assistant
Nurse
Other
Other Health Care Provider (please specify):

*Are you a practicing physician?
YesNo

*Affiliation:
Solo Practice
Solo Practice-Shared Facility
Small Group Practice (Less than 3 Physicians)
Medium Group Practice (3-9 Physicians)
Large Group Practice (More than 10 Physicians)
Hospital
Medical School
None

*Applying for CME credit: YesNo

*Street address (mailing address):

*City:

*State: