CPD Application Form FFLM CPD Application Form FFLM Course DetailsCourse Name** Start Date** DD slash MM slash YYYY End Date** DD slash MM slash YYYY Venue . Location** Fee(s) to be charged to the delegates:* Number of hours (excluding break times)* Date of previous course DD slash MM slash YYYY Educational Details / Course ContentPlease provide details of primary purpose of event*Please list the Learning Objectives for the event below. The objectives should reflect measurable learning contents and be relevant to the target audience*How will the educational content of the event be evaluated by participants?*The following questions need to be included in the evaluation 1. Were the printed learning aims and outcomes of the course met? 2. Was there any bias or conflict of interest evident in the course 3. Was the instructor/speaker organised and knowledgeable? Attendance certificates*Please confirm certificates of attendance will be issued and agree to supply to the participant or the Faculty, on request. Yes No Target audience*Please tick all that apply Medico-legal Advisers Forensic Medical Practitioners Coroners Others Please state other* Are there any conflicts of interest*Please tick all that apply Yes No Please provide details of any potential conflicts of interest below specifying nature of potential conflict, steps taken to manage conflict and 3rd parties involved. Guidelines on conflicts of interest can be found at the back of this form. Please continue on a separate sheet if required.Date DD slash MM slash YYYY EmailThis field is for validation purposes and should be left unchanged.
