1 Start 2 Complete Activity Title * Please copy and paste the title of the activity here Links to:AAAAI Disclosure PolicyAAAAI Faculty Reimbursement Guidelines for Direct- and Jointly-Provided CME Activities Does the activity align with the AAAAI CME Mission Statement? * YES NO Explain (Mission Statement) Planning Committee Review Did you identify any possible conflicts of interest in your planning committee disclosure review? * Yes No If yes, did you recommend a resolution? Yes No Does the application specify if commercial support will be sought to help fund this activity? * Yes No If no, please explain. Attachments Completed COI Review - Planning Cmte Upload/Attach the completed COI review of the Planning CommitteeFiles must be less than 2 MB.Allowed file types: gif jpg jpeg png pdf doc docx. Approval Approval * Approved Approved with revisions (enter below) Denied Recommended revisions: Comments re: denial: Please explain why you recommend denying CME for this activity. Reviewer's Name * Typing your name into this field is the electronic equivalent of your signature Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20222023202420252026 Revisions Leave this field blank
