PELI Advanced Enrollment

Questions about the course? Please visit www.hanleyleadership.org

Other questions? Please contact Judiann Smith at judiannsmith@hanleyleadership.org or 207-553-9852.

This activity has been planned and implemented in accordance with the Essentials and Standards of the Maine Medical Association Committee on Continuing Medical Education and Accreditation through the partnership of Maine Medical Education Trust and Daniel Hanley Center for Health Leadership. The Maine Medical Education Trust is accredited by the Maine Medical Association to provide CME activities for physicians. Full completion of the PELI Advanced course yields 80 Category One CMEs.
Name*
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Preferred Pronouns*
Credentials
Organizational Affiliation*
Position*
Years of Professional Experience*
Years of Leadership/Management Experience*

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Personal Profile
CV
Please attach a current resume or curriculum vitae.
Max. file size: 300 MB.
Strengths*
Please describe your unique strengths, interests, background, attributes or dimensions of diversity that you will bring to the cohort.
Gain*
Please briefly describe what you hope to gain for yourself and/or your organization from the PELI Advanced Course. If you have completed other leadership development courses, please tell us about them.
Enrollment Fee - $100

A non-refundable enrollment fee is required from all prospective enrollees. Your enrollment will not be considered complete until the fee is received.
Enrollment Fee*
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PELI Advanced Enrollment Fee
If you prefer, you can mail a check for $100 to Daniel Hanley Center for Health Leadership PO Box 4606 Portland, ME 04112

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