SMRT CE Credit Application for Seminar or Lecture Activity

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. Sponsor Information
Name of Organization/Company*
Contact Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Email*
Contact Phone*
2. Activity Identification
If you are submitting a self-learning activity, please use the Self-Learning Module form.
Prior CE Reference Number*
For renewals only
Title of Activity*
Location*
Scheduled Date*
Note: Please allow at least 30 days from the date of submission for processing.
* For expedited service, please see additional fees below.
Date Format: MM slash DD slash YYYY
Activity Length*
Speakers, Authors, and/or Presenters*
• Please upload each person's CV in section 3 below.
• Click the (+) icon to add additional lines.
First Name Last Name Email
Has this module ever been submitted or approved for CE credit by any other RCEEM, RCEEM+, or SLA?*
- Yes
- No
Please list all prior approvals here, including organization name and reference number.*
3. Accreditation Documentation

Please upload all of the following:
CV(s) or resumes for each Speaker, Author or Presenter*
For multiple speakers, authors, or presenters, please combine all CVs/resumes into a single .zip file.
Accepted file types: txt, rtf, doc, docx, pdf, zip.
Objectives for each activity or lecture*
Sample Objectives:
After attending this [activity/lecture/session], the attendees will be able to:
Understand the limitations of size and morphology in accurate nodal characterization
Understand the principles of emerging new techniques that can be used for accurate nodal staging
Understand what some of the key pointers are for optimizing MR technique for nodal detection and characterization
Accepted file types: txt, rtf, doc, docx, pdf.
Overview for each activity or lecture*
Sample Overview:
The proposed [activity/lecture/session] will highlight the current limitations of MRI in characterizing lymph nodes and provide an overview of the emerging new techniques that overcome some of these limitations.
Accepted file types: txt, rtf, doc, docx, pdf.
Signed Liability Release Form*
Download the form here.
Accepted file types: txt, rtf, doc, docx, pdf.
Copy of program, brochure/flyer, or schedule*
Accepted file types: txt, rtf, doc, docx, pdf.

4. Fees

Fees are non-refundable.

Annual Approval: Single lecture activity or renewal (regardless of length) • 1 year • 2 year • 3 year	$145 $250 $350
One-Day Programs: • Single/multiple lectures, up to 2 hours • Single/multiple lectures, 2-4 hours • Single/multiple lectures, more than 4 hours	$65 $85 $105
Multi-Day Programs: • 2 day programs • 3 day programs • 4 day programs	$170 $255 $340

Approval Type*
CE Fees for Course or Per Day Seminar*
$5 per CE credit
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.

First Name	Last Name	Email