Annual Meeting Speaker Agreement Speaker Agreement for Ohio Chapter, American Academy of Pediatrics Continuing Medical Education Annual Meeting 2017 Section I - Personal Information Name: * First Name, Last Name & Credentials AAP ID# Email Address * Cell Phone Number (for use by staff during the conference): Address: City: State: ZIP: Section II - Important Deadlines Please note the deadlines below: CME Disclosure: 4/15/17 Marketing and Objectives: 4/15/17 PowerPoint Presentation – 10/2/17 Section III - Conflict of Interest and Faculty Disclosure: A conflict of interest is considered to exist if an individual has both a financial relationship with a commercial interest and the opportunity to affect the content of CME about the products or services of that commercial interest. A financial relationship includes all of the following as may relate to the individual, spouse, family member, partner or significant other: employment; royalty; intellectual property rights; consulting fees; honoraria; stocks or stock options, excluding diversified mutual funds; other financial benefit. Individuals who refuse to provide disclosures will be disqualified from participation in the CME activity. Please visit to complete disclosure form: CLICK HERE Section IV - Conference Program, Online and Mobile App Listing: Please type the following information exactly as you wish it to appear for your published faculty listing. Full Name and Credentials Primary Professional Title(s): Primary Institutional Affiliation: City: State: Section V - Introduction for Session Moderator: In the space provided below (limit to 150 words or less), please provide us with a brief introduction for use by the session moderator. The moderator will introduce you/your session and will be available to field audience questions if you wish her/him to do so. If your name is difficult to pronounce, please spell it phonetically in the introduction as in the sample introduction provided below for your convenience. Section VI: Marketing and Objectives Objectives: Please provide 3 learning objectives for your presentation or panel involvement. Objectives will clearly and concisely communicate what an attendee is expected to know and/or do at the conclusion of an activity. Objectives must be included in the brochure so the attendees may evaluate the relevance of attending a CME activity. Marketing: Please provide a short marketing paragraph that will be used to promote your session on the brochure, online and through social media. Signature Draw It Type It Clear
Speaker Agreement for
