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Register for coursework provided through this website. You only need to register once to create a Continuing Medical Education account. After you register, you can access your account by typing in your user name and password. All fields denoted with an * are required.

Username: *
Password: *
  • passwords must be a combination of least 6 letters / numbers
  • at least 1 character must be a number
  • password must contain at least 1 uppercase letter


    		•
    Confirm Password: *
     
    Primary Contact Information
     
    Check here if you are a Medical Resident:
     
    Title: *
    First Name: *
    Middle Initial:
    Last Name: *
    ABP Diplomate ID#:
    Degree: *   If Other:
    Specialty: *   If Other:
    Gender: *
    Date of Birth: * / /    [mm/dd/yyyy]
    Address: *
    City: *
    State: *
    Zip/Postal Code: *
    Country: *    If Other:
    Email: *
    Confirm Email: *
     

    Non-New York State practioners—please scroll to last question at bottom of the form ("I understand...").

     This section is to be completed by New York State practitioners only.
    NYS County of Practice: *
    Please indicate your county of practice (check all that apply):
    None
    Albany
    Allegany
    Bronx
    Broome
    Cattaraugus
    Cayuga
    Chautauqua
    Chemung
    Chenango
    Clinton
    Columbia
    Cortland
    Delaware
    Dutchess
    Erie
    Essex
    Franklin
    Fulton
    Genesee
    Greene
    		Hamilton
    Herkimer
    Jefferson
    Kings
    Lewis
    Livingston
    Madison
    Monroe
    Montgomery
    Nassau
    New York
    Niagara
    Oneida
    Onondaga
    Ontario
    Orange
    Orleans
    Oswego
    Otsego
    Putnam
    Queens
    		 Rensselaer
    Richmond
    Rockland
    Saratoga
    Schenectady
    Schoharie
    Schuyler
    Seneca
    St. Lawrence
    Steuben
    Suffolk
    Sullivan
    Tioga
    Tompkins
    Ulster
    Warren
    Washington
    Wayne
    Westchester
    Wyoming
    Yates
    Practice Group Name:
    Facility/Health Care Org:
    Department:
    Work Phone:
    Work Fax:
    Affiliated With: *
    Name of CAC/MDT:
    Your Affiliated Title:
     
    Additional Contact Information (if necessary)
    Address:
     
    City:
    State:
    Zip/Postal Code:
    Phone:
    Fax:
     
     
     

    I understand that the data that I provide as part of a CHAMP educational program may be used for research purposes regarding continuing education, pending approval by the SUNY Upstate Medical University Institutional Review Board. Choosing not to participate in this research will not affect my course performance evaluation or eligibility for Continuing Medical Education credit in any way whatsoever. *

    Today’s Date:
    3/21/2023

    If your registration is successful, you will next see a screen confirmation.
    If you are unable to register, you can contact JoAnne Race, CHAMP Manager at champ@upstate.edu or go to the CME contact page .







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    Syracuse, New York
    www.CHAMPprogram.com
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