Faculty Info:

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Areas of Expertise

Geographic/day/evening preferences or limitations

If you have a continuing education activity/program idea, please tell us about it below.

Program Title

Topic Area (i.e. women's health, cardiology)/subject (i.e. pregnancy, CHF)

State the identified practice gap related to the proposed presentation and the evidence that supports it

Program Length
—Please choose an option—1 hr1.5 hr2 hrhr, half dayfull day

Will the activity be knowledge-based (K), application-based (A), or a practice-based(P)?
—Please choose an option—knowledge-based(K)application-based (A)practice-based(P)

Brief summary of the program

As a NJPhA member benefit, each issue of the New Jersey Journal of Pharmacy has a CE article posted to our website (free for members). Would you be interested in volunteering to author a home study CE or know an interested colleague?
—Please choose an option—Yes!No, thank you

Please provide your CV with the completed form