American Society of Addiciton Medicine

Treatment of Opioid Use Disorder Course Host Interest Form

Education

Treatment of Opioid Use Disorder Course Host Interest Form

Home Education Host a Course Treatment of Opioid Use Disorder Course Host Interest Form 

Thank you for your interest in hosting The ASAM Treatment of Opioid Use Disorder Course: Includes Waiver Qualifying Requirements. Hosting a course requires a minimum of four (4) months advanced notice. Please fill out the below form to initiate the process for setting up a meeting to discuss hosting a course.

Please note that due to a high volume of requests, you can expect a response within 3-5 business days. Meetings are typically scheduled 1-4 weeks from the date of your request. 

Who will be hosting the course?

Who will serve as the point of contact for course planning purposes?

Who will serve as the point of contact for course planning purposes?

What is the best phone number to contact the point of contact?

What is the best email to contact the point of contact?

Please provide the target date for the workshop. Workshops require a minimum of 4 months advanced notice to be scheduled.

Where will the course take place?

How many learners does the host want to reach?

What is the target audience you are trying to reach for this course? Examples: providers in a specific state or geographic region; providers in my hospital system; Ob-Gyn providers

Course Format

Is there a specific faculty person the host would like to request? All faculty must be approved by ASAM.

Will this course be open to the public?

Is the host open to collaborating with outside organizations?

Do you have any funding available to put toward this course?

Are you open to your participants paying a registration rate for the course?

If no, use "N/A"

Please enter your comments or questions here.