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Please complete the entire form and click 'Submit' when finished. Your responses will be kept strictly confidential.
If you have questions about this form please contact the ACR Office of Chapter and Volunteer Development at (800) 401-1438 or at chapters@acr.org.
Thank you for your participation. |
| Name: |
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| Position in Chapter: |
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| Chapter: |
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| Meeting Overview |
| What type of meeting? |
| Business Educational Combined |
| Meeting or educational event date: |
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| Event Location: |
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| Program topic and speakers: |
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| Brief synopsis of the program: |
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| CME |
| Did the program offer CME credit? |
| Yes No |
| If you answered "Yes", please complete the following three questions. |
| What type of credit? |
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| How much credit? |
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| Who was the ACGME accredited sponsor? |
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| Meeting Attendance |
| Number of members who attended? |
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| Number of nonmembers who attended? |
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| Was there a registration fee? |
| Yes No |
| If you answered "Yes" please complete the following two questions. |
| Fee for members? |
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| Fee for nonmembers? |
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| Marketing Strategy |
| Please indicate all the ways you promoted this event. |
| Mailing? |
| Yes No |
If "Yes," please indicate the number of pieces sent.
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| Broadcast Fax? |
| Yes No |
If "Yes," please indicate the number of people sent to.
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| Broadcast E-mail? |
| Yes No |
| Chapter Web site? |
| Yes No |
| Chapter newsletter? |
| Yes No |
| ACR Bulletin |
| Yes No |
| ACR Radiology Calendar (found on the ACR Web site)? |
| Yes No |
| Other (please describe.) |
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| Meeting Logistics |
| Please indicate whether or not you did any of the following: |
| Rented meeting space? |
| Yes No |
If "Yes," what was the cost?
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| Served food and beverages? |
| Yes No |
If "Yes," what was the cost?
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| Used AV equipment? |
| Yes No |
If "Yes," what was the cost?
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| Provided a fee or honorarium for a speaker(s)? |
| Yes No |
If "Yes," what was the cost?
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| Other costs (please explain.) |
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| Meeting Innovation |
| Please use the space below to explain how this meeting was innovative for your chapter. |
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Thank you for completing the Single Meeting Information Form (EZ).
Please contact the ACR Office of Chapter and Volunteer Development with questions or concerns at either chapters@acr.org or (800) 401-1438. |