Inspired Learning

Please note: All fields are required.

Institution or Organization Information

Contact Information

Proposed Activity Date, Time and Location

Date Time

Anticipated Attendee Information

  20 - 30
  30 - 40
  40 - 50
  50+
  Other    

Attendee Titles (approximate number)

  
  
  
  
  

Publicity Methods

Please check which method(s) you will use to publicize this program. We will provide you with the materials per your request. (Check all that apply)

  Poster
  E-mail Promotion
  Press Release
  Calendar of Events
  Other    

Local Community Physicians

Do you plan on inviting local community physicians?      Yes      No

If yes, how will you invite them?


Permission for representative from supporter to attend?      Yes      No

In order to ensure that this educational activity meets the needs of your institution or organization, please identify the current professional practice gap(s) of your staff that you would like to see improved as a result of their participation in this activity.

What barriers exist to addressing the professional practice gap(s) identified above?

What practice changes do you expect to see as a result of your staff’s participation in this educational activity?

  I agree to be contacted to complete a brief outcomes survey two to four months following this activity.


I understand that this activity is accredited for continuing medical education by the Postgraduate Institute for Medicine and will not be accredited by another entity.

Please check here to indicate that you have read and understand this statement.


For assistance or questions regarding this program, please contact Spire Learning at 973-605-2922 and reference Hypertension Grand Rounds - 654.