ACEM CPD Activity Participation Register Form

ACEM CPD Activity Participation Register
Provider Name/Organisation:*
Email*
example@example.com
Activity Name*
Venue*
Date of Activity*

DayMonthYear
Date
Duration of Activity*
(Excluding registration)
Did your activity have Procedural Skills?*

No it didn'tYes it didI've already submitted these to the CPD unit
Please list the Procedural Skills*
Please list the procedural skills that were performed during this activity*
Mode of participation*

PerformedSupervisedTaught
Simulation*

AdultPaediatricOther
Attendant Information
Select the ADD button to save each entry
Please use the template located here if you wish to upload details of a large number of participants.
Excel file upload

For large number of participants, an excel spreadsheet can be submitted in place of completing the Attendant Information section, however this form and the Activity Details section must be submitted.
Cancelof
Should be Empty:

ACEM CPD Activity Participation Register