/ THE COLLEGE OF DENTAL SURGEONS OF HONG KONG
(Incorporated with Limited Liability)
A ConstituentCollege of the Hong KongAcademy of Medicine /
CME Accreditation Application Form
(By fax or e-mail only)For Official Use only:
Part 1: Details of Applicant: / CDSHK Application No.:
*Name of Applicant (in full):
Company Name(if applicable):
*Telephone No.: / *Fax No.:
*Date of Application: / *E-mail Address:
Part 2: Details of Event:*Name of Organization(s)
*Title of Course/Programme:
(Abstract to be attached)
(CV to be attached)
*Date(s) of Event: / *Duration:
(e.g. 12:00-13:00) / to
Remark / Fields marked with *are mandatory. Application with incomplete or incorrect information may cause processing delay and errors, or may even be rejected. For full details,please refer to theCDSHK P&G-Explanatory Note, which can be found in the College’s web-site.
Admin. Fee: / Cheque No.: / Name of Bank : / Amount received:
Please indicate in the box(es) below with “√ ” which CME/CPD Programmeto be applied:
CDSHK CME/CPD Programme
DCHK CPDProgramme *if the organizer is not one of the pre-approved DCHK CPD programme providers, the event must be a “co-organized” one, otherwise it will not be considered.
Remarks of CME accreditation application
CME/CPD activities organized solely by institutions currently recognized by CDSHK as ‘CME/CPD Providers’ are deemed ‘Formal College Approved Activities’ (FCAA) and do not need prior-approval. All other CME/CPD activities must seek the College’s prior-approval. The list of currently recognized ‘CME/CPD Programme Providers’ is available from the College’s website.
Application for pre-approval and accreditation of CME/CPD activities
- Fill-in and return the ‘CME Accreditation Application Form’ together with the following materials for processing at least two weeks before the event.
- Speakers’ CV or biography; event brochure and promotion materials.
- Detail rundown/programme of the event including lecture title, duration of opening speech/tea break/lunch breaka, etc;
- A cheque of HK$3,000 payable to ‘The College of Dental Surgeons of Hong Kong’ as administration fee if any commercial company is involved in supporting, sponsoring or co-organizing the event, whether or not commercial products/materials are being promoted before, during or after the event.
- Late or retrospective application will incur an additional administrative cost of HK$3,000, i.e. a total of HK$ 6,000 will be chargeable, or the application will not be processed.
Organizer(s) of the CME/CPD activity should note:
- Successful application will be issued a ‘CME Accreditation CDSHK REPLY FORM’ with the maximum accredited CME/CPD points stated. This piece of information can only be disseminated in the following format: “CDSHK(CME/CPD): X pts, DCHK(CPD): X pts”. Logos of CDSHK and/or HKAM cannot be used without prior approval.
- When there are changes in the event/programme (date, venue, speakers, lecture title/duration, etc), the updated information must be submitted two weeks before the event for reassessment of accreditation. Deviation of the programme from the information submitted will be deemed non-compliance to the Guidelines.
- It is the responsibility of the organizer(s) of the activity to make sure that all the attending participants and Speakers/Chairpersons have filled-in and signed on the respective forms [CME/CPD Programme Attendance Form (For Participants) and CME/CPD Programme Attendance Form (For Speakers and Chairpersons)] and return them to the College Secretariat by post, e-mail, or fax within two weeks after the event. CME/CPD points will only be credited when ALL the required information is entered and legible. Dishonesty in entering the information on the Forms is considered a serious fraud and will be reported to the College Council.
- Non-compliance of the Guidelines and/or provision of incomplete/incorrect/misleading information along with the application may result in revision/invalidation of the approved CME/CPD points, rejection of future application, and/or removal from the list of College recognized ‘CME/CPD Provider’.
- Latest version of the forms must be used which can be downloaded from the College website. Old versions or self-made forms are not acceptable.
- For detail information, please refer to the current ‘Principles and Guidelines on CME and CPD 2017onwards’ available at the College website.
aIf tea/lunch breaks etc. is not specified in the submitted programme , it will be assumed that there will be a 30-minute tea break in each morning and afternoon session. Lunch (between morning and afternoon sessions) and dinner (between afternoon and evening sessions) breaks will be assumed to take 60 minutes. These breaks will not attract CME/CPD points. If the lecture runs concurrently with lunch/dinner, it should be specified in the application for consideration.<Version: January 2017 / Rm.902, HKAMJockeyClubBuilding, 99 Wong Chuk Hang Road, Aberdeen, HK
Tel: 2871-8866Fax: 2873-6731E-mail:
*** E-mail address for CME matters : *** / Page:1 of 2