CME Notification List Privacy notice Any personal information you provide will be used solely for communication by the UF Office of Continuing Medical Education and will not be shared with other entities. Contact Information First name Last name Degree Specialty Area Phone Fax Email Address Address 2 Address 3 City State Zip Notification Preferences Indicate how you prefer to be contacted by the UF CME Office at UF Health Jacksonville (notify your office staff if you do wish to be contacted by us): E-mail Fax Mail Phone I do not wish to be contacted at this time Do you want to be added to the list to receive a brief, one- to two-page electronic newsletter from the CME Office? Yes No Not at this time If yes, how often would you like to receive a newsletter via e-mail? Monthly Quarterly What topics would you like to see included in the CME Newsletter? Upcoming course offerings Florida Board of Medicine and CME news items UF Health Jacksonville news items of interest to local medical community Biosketches of University of Florida CME instructors Comments: Categories Please check all the categories that you are interested in receiving advance notice of upcoming CME activities: Allergy/Rheumatology Alternative/Complementary Medicine Anesthesiology Cardiovascular Medicine Critical Care Medicine Dermatology Emergency Medicine Endocrinology Ethics Family Medicine Gastroenterology Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Neurosurgery OB/GYN Oncology Ophthalmology Orthopaedics Otolaryngology Pain Management Pathology Pediatrics Psychiatry Pulmonary Medicine Radiation Oncology Radiology Required Courses (HIV, Domestic Violence, Medical Errors) Risk Management Surgery Urology Other (please list other categories or areas of interest) Other: Type the code from the image