SMRT CE Credit Application for Corporate Provider

Please submit a separate application for multiple seminars/lectures.

Please complete all fields below.

Application Type*
- New Application
- Annual Renewal where no more than 50% of the educational content has changed since its last accreditation
Note: If the educational content has changed by more than 50%, you will need to submit a new application.
1. Corporate Provider Information
Name of Company*
Contact Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Email*
Contact Phone*
Organizations or individuals that submit for approval more than 25 educational activities during a one-year period may save money by becoming corporate CE providers. After this application is processed, the SMRT assigns a provider number that should be used on all Request for Approval forms. The provider number is a business ID number only and is not used as a reference number for individual CE activities. Each educational activity is approved for one or two full years from the date of approval or initial presentation regardless of the ending date of the providership year. Corporate providers are not allowed to self-approve their own activities.
2. Corporate Provider Fee Structure

Fees are non-refundable.

Number of Activities Cost for Each Activity

1-24 $150

25-49 $130

50-99 $125

100-149 $120

150-199 $115

200-299 $110

300-400 $105

401-500 $100
Number of Activities*
Corporate provider fees are non-refundable and are based on the number of activities they wish to submit for approval during the one-year period. If a Corporate Provider does not reach the number of activities proposed for the year, the credits do not roll over to the next year, they are forfeited. The Corporate Provider fee structure is good for any seminar or lecture, or self-learning activity up to three hours in length.
Please enter a number from 1 to 500.
Subtotal with Base Fee of $150.00
Enter the number of activities you wish to submit for this period.
Price: $0.00
Subtotal with Quantity Discount
-$20.00 each for 25-49 activities
Price: $0.00
Subtotal with Quantity Discount
-$25.00 each for 50-99 activities
Price: $0.00
Subtotal with Quantity Discount
-$30.00 each for 100-149 activities
Price: $0.00
Subtotal with Quantity Discount
-$35.00 each for 150-199 activities
Price: $0.00
Subtotal with Quantity Discount
-$40.00 each for 200-299 activities
Price: $0.00
Subtotal with Quantity Discount
-$45.00 each for 300-400 activities
Price: $0.00
Subtotal with Quantity Discount
-$50.00 each for 401-500 activities
Price: $0.00
Expedited Processing Fee*
Select this option if your event/publication date is LESS THAN 30 days from the date of this submission.
- Regular (30 day) Processing
- Expedited Processing = $50.00
Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Click here if your card's billing address is the same as the organization/company address above.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Total
This amount (in US dollars) will be charged upon clicking the Submit button below.
$0.00
By clicking the Submit button, I hereby apply to the Society for MR Radiographers & Technologists for application processing and authorize my credit card to be charged the above amount.

Number of Activities	Cost for Each Activity
1-24	$150
25-49	$130
50-99	$125
100-149	$120
150-199	$115
200-299	$110
300-400	$105
401-500	$100