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Mid-Atlantic MedWAR
CME/CE Credit Application Form

To register to receive CME Credit for participation in the Mid-Atlantic MedWAR Race, please fill out the form below. You will sign it at check-in. To obtain CME credit, you must register in advance. You cannot register for CME credit on Race Day.

CME credits will be included in the registration fee, and will not incur a separate charge.

First Name*: Last Name*:

Affiliation: (School/Hospital/Organization/etc.)

Occupation*: If Other:

Type of CME Credit*:

Last 4 digits of your Social Security Number*:


Street Address*:
City*: State/Province*:
Phone Number:


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