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CPE Activity Form
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Please complete the following for your planned Continuing Pharmacy Education activity.

Please note underlined field labels have additional information. Mouse over the label to view.

Please indicate the following in planning this activity.

Please select ONE of the following activity types.


Please develop 3-5 appropriate learning objectives for the indicated audience. Objectives should be S.M.A.R.T (Specific, Measurable, Attainable, Results-Focused, Time-Focused).

If the target audience includes Pharmacists and Pharmacy Technicians, each must have SEPARATE AND DISTINCT objectives, specific to their respective roles in Pharmacy.
Please complete the following relative to after the completion of the activity.
In an effort to keep meeting costs lower, LPA provides electronic versions of all educational material pre- and post-convention (unless otherwise specifically requested). Please list any of the material that you request be printed and available to all attendees at the convention.
LPA provides a podium with wired microphone, laptop, projector and screen. Please list any other requests for your activity.





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