Pharmaceutical CME Partnership Application Form Pharmaceutical CME Partnership Application Form Pharmaceutical CME Partnership Application Form Company Information: Company Name: Contact Person: Position: Phone Number: Email Address: Event Details: Preferred Webinar Date: Event Theme: Speaker(s) Name(s) and Titles: Presentation Topic(s): Participation Details: Are you inviting specific physicians? Yes No Estimated Number of Attendees from Your Invitation: Will you be providing promotional materials? Yes No Do you require assistance with advertising? Yes No We agree to provide the list of invited physicians Yes No Agreement and Payment: I agree to the AGPJ CME Partnership Terms and Conditions. Yes No Payment Amount (Cost per Speaker – $100,000 JMD): I agree that if the event is Hybrid, I agree to pay 100% of the Associated cost, eg venue, AV and multi-media. Yes No Signature: Date: For further information, please contact AGPJ at agpjsecretary@gmail.com or agpjamaica@gmail.com or telephone: 876-517-6636 or 876-946-0954 Captcha If you are human, leave this field blank. Submit
