University of Maryland School of Medicine Office of Faculty Affairs and Professional Development CME Activity Support Log (Commercial Grantors, Exhibitors, Other) Activity
Date(s)
Activity No.
COMMERCIAL SUPPORTERS (A Commercial Support Agreement must be executed. A Complimentary Exhibit Form is required to exhibit.) Drug/Device Company (Legal Name)
Representative/ Contact Information
Specify online grant request or solicitation letter
Date online request submitted or letter sent
Specify amount of funds requested or inkind contribution
Date letter of Amount agreement of funds executed received
Date funds received
Other Information: support acknowledgment (syllabus, signage); official thank you
Comments
03/08
1
University of Maryland School of Medicine Office of Faculty Affairs and Professional Development CME Activity Support Log (Commercial Grantors, Exhibitors, Other)
EXHIBITORS (An Exhibit Agreement must be executed.) Agency/Company/ Organization/Society/Other
Representative/ Contact Information
Exhibit Space Fee
Agreement Sent/Received
Amount Received
Date Received
Other Information (e.g., specific requirements, extra charges to be billed)
Comments OTHER SUPPORTERS (e.g., funding from federal or state agencies, nonforprofit associations, philanthropic organizations) Company*/Foundation/ Institution/Society/Other
Representative/ Contact Information
Confirmation Received
Amount Pledged
Amount Received
Date Received
Other Information (e.g., support acknowledgment)
*NonFDA regulated company
Comments
03/08
2
University of Maryland School of Medicine Office of Faculty Affairs and Professional Development CME Activity Support Log (Commercial Grantors, Exhibitors, Other)
03/08
3