CME Activity Request Form CME Activity Request Form Program Manager Name: Proposed Activity: Type: Live Enduring (Recorded or Web-based) MOC Part II Requested? * Yes No Proposed Launch Date for Enduring Activity Please select the option that best fits your activity: Live Course (Single Session) RSS - Regularly Schedule Series (Recurring Sessions) Proposed Date of Activity Proposed Dates of RSS (Recurring Sessions) Proposed Topics For example: Obesity, Mental Health, Advocacy, etc. Estimated Hours Exhibitors: Yes No Sponsors Yes No MOC Part II Only: You are required to have two non-author physicians peer review your activity using this Peer Review form. You must keep record of all peer review documentation and will be asked to upload the review in the CME Activity Application. If you are human, leave this field blank.