Annals of Allergy, Asthma, & ImmunologyContinuing Medical Education

Activity Evaluation FormA. Instructions to obtain Category 1 CME Credits:1. Read the CME article in this issue carefully and complete the activity by answering the self-assessment exam questions on

the form below.2. To receive CME credit, complete the entire form and submit it to the ACAAI office within one year after receipt of the Annals.

B. Quiz and Evaluation:1. Circle answer:

Q1. a b c d e Q5. a b c d eQ2. a b c d e Q6. a b c d eQ3. a b c d e Q7. a b c d eQ4. a b c d e Q8. a b c d e

2. Circle “Yes” or “No”Yes No A. The article met its learning objectives.Yes No B. I verified some important information.Yes No C. This activity will influence how I practice medicine.Yes No D. Was the article format conducive to learning?

3. Rate the overall effectiveness of the CME activity:

5 (very effective) 4 3 2 1 (not at all effective)

C. I, certify that I have met the criteria for CME credit by studying the designated materials,by responding to the self-assessment questions, by reviewing those parts of the article dealing with any questions(s)answered incorrectly, and by referring to the supplemental materials listed in the references.

(Sign here) (Date)

D. Please indicate the issue and volume this form represents: Year Month Volume

E. Hours claimed: (This educational activity is designated for 2 Category 1 CME credits.) Indicate total hours claimed(max. of 2 hours)

F. ChargesRecording of Annals CME credits is provided to members of the American College of Allergy, Asthma, & Immunology at a costof $25 per year. Nonmembers will be charged $50 per year. This cost will cover processing of forms and reporting of CME creditsearned during the year. Participants will be provided with an annual report on the number of CME credits earned each year.Checks are to be in U.S. funds payable to the American College of Allergy, Asthma, & Immunology.

G. Participant information:

Name(Please print)

Address

City State Zip

Return completed form to:Attn: CME Coordinator; The American College of Allergy, Asthma, and Immunology; 85 West Algonquin Rd, Suite 550;Arlington Heights, IL 60005 Fax 1-847-427-1294

392 ANNALS OF ALLERGY, ASTHMA & IMMUNOLOGY

Annals of Allergy, Asthma, & ImmunologyCME – Needs Assessment

Part of the mission of The American College of Allergy, Asthma, and Immunology is to better serve the CME educational needsof our membership and readership. We ask you to identify the areas of CME education that you feel need to be addressed. Wewill collate the subject needs yearly and plan to have certain of these educational subjects published in the Annals.Please list subjects that reflect your educational needs and interests and fax to: ACAAI at 847-427-1294

DateName (optional)

VOLUME 99, NOVEMBER, 2007 393