JSEI CLINICAL RESEARCH SEMINAR - Jules Stein Eye Institute

Registration
Jules Stein Eye Institute
Clinical & Research Seminar, May 21–22, 2004
Enclosed is my remittance (U.S. currency), payable to UC Regents, for the Jules Stein Eye
Institute Clinical and Research Seminar on May 21– 22, 2004.
Name Degree
Specialty
Address
City State Zip
Telephone Fax
E-Mail
Registration Fees (Includes continental breakfast, lunch, reception, and course materials)
■ $115 for practicing ophthalmologists and optometrists (non-refundable)
■ No charge for ophthalmology residents and fellows who submit a letter of verification
from the training program along with registration form.
Make checks payable to UC Regents or pay by credit card (complete form below)
■ Mastercard ■ Visa ■ American Express
Name as it appears on credit card
Account Number Expiration
Signature
Register by May 14, 2004
Academic Programs
100 Stein Plaza, Room 3-223
Los Angeles, CA 90095
310.825.4617 Telephone
310.206.8015 Fax
CME Sponsor: The Office of Continuing Medical Education, David Geffen School of Medicine at UCLA, is
accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education
for physicians.
Accreditation: The Office of Continuing Medical Education, David Geffen School of Medicine at UCLA, designates
this continuing medical education activity for 13.5 Category 1 credits toward the American Medical
Association Physicians Recognition Award.
Each physician should claim only credits that he/she actually spent in the educational activity.
UCLA Conflict of Interest Disclosure: The FDA has issued a concept paper which classifies commercial
support of scientific and educational programs as promotional unless it can be affirmed that the program is
“truly independent” and free of commercial influence. In addition to independence, the FDA requires that
non-promotional, commercially supported education be objective, balanced, and scientifically rigorous. The
policy further states that all potential conflicts of interest of the CME staff and faculty be fully disclosed to
the program’s participants. We, at UCLA, fully endorse the letter and spirit of this concept.
In compliance with this policy, the program audience will have disclosed to them any potential conflict(s) of
interest related to the contents of presentations made by all faculty participating in sponsored or jointly sponsored
programs by the David Geffen School of Medicine at UCLA.