ASPS Joint Providership Fee Estimate Worksheet

Activity Information

Title of Activity

Activity Date(s)

Activity Location

Organization

Primary Contact

Phone

Section I: Application Fee

Application Fee ($500) Late Submission Fee (+$2,500)

Application Subtotal

Section II: CME Credit Fee

CME Credits Requested

CME Fee ($225/credit)

Section III: Accreditation Management Fee (Faculty-Based)

Total Faculty Count

Tier Fee (auto)

Faculty tiers: 1–10 $3,000; 11–25 $4,000; 26–50 $5,000; 51–75 $6,000; 76–100 $7,000; 101–125 $8,000; 126–150 $9,000; 151–175 $10,000; 176–200 $11,000; 201–225 $12,000; 226–250 $13,000; 251–275 $14,000; 276–300 $16,000; 300+ TBD.

Section IV: Abstract Co-Author Fee (Non-Presenting Only)

Non-Presenting Abstract Co-Authors (count)

Fee ($20 each)

Section V: Optional Add-Ons

Educational Grant Management (count)

Fee ($500 each)

ASPS Promotional Support emails (count)

Fee ($1,250 each)

Customized Reporting estimate ($350–$600)

Estimated Total

Estimated Grand Total

If faculty count is 300+, totals display TBD.

Attestation & Signature

Name

Title

Date

Signature

Joint Providership Planning and Fee Structure

Fee Estimate Worksheet (To Attach to Application)