1. Speaker Name Speaker Affiliation
Presentation Title
Speaker Name
Speaker Affiliation

2. [FOR APHA USE ONLY] Attendance Code
You will need this attendance code in order to access the evaluation and CPE form for this activity. Your CPE must be filed by December 2, 2016, at 1700 EST in order to receive credit.

3. CPE Information and Disclosures
[INSERT FACULTY NAME(S)] [INSERT THE FOLLOWING TEXT IF NO CONFLICTS EXIST: “declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.” OR LIST THE CONFLICTS]
The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

4. CPE Information Target Audience: [FOR APHA USE ONLY]
ACPE#: [FOR APHA USE ONLY]
Activity Type: [FOR APHA USE ONLY]

5. Learning Objectives
Objective 1
Objective 2
Objective 3

6. Self-Assessment Questions

7. Slide Content
Slide content starts here (add slides as needed)

8. Key Points
[INSERT KEY POINTS OF PRESENTATION AS REVIEW FOR AUDIENCE]

9. Answers To Self-Assessment Questions
Question 1 and answer
Question 2 and answer
Question 3 and answer

10. Speaker Name Speaker Affiliation Speaker Contact
Closing Remarks
Speaker Name
Speaker Affiliation
Speaker Contact

11. [FOR APHA USE ONLY] Attendance Code
You will need this attendance code in order to access the evaluation and CPE credit for this activity. Your CPE must be filed by December 2, 2016, 1700 EST in order to receive credit.