Annual Meeting Speaker Agreement

OhioAAPSpeaker Agreement for
Ohio Chapter, American Academy of Pediatrics
Continuing Medical Education
Annual Meeting 2017


Section I - Personal Information

First Name, Last Name & Credentials

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:

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.

Section V - Introduction for Session Moderator: 

Section VI: Marketing and Objectives