Speaker Information

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JULY 11-13, 2024

ATTENDEE INFORMATION

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ACVP Veterinary Pharmacy Conference – Speaker Agreement and Information

Thank you for agreeing to speak at the 2023 ACVP Veterinary Pharmacy Conference. Please complete the speaker agreement below by March 1st, 2023. This agreement is made between the Speaker and the American College of Veterinary Pharmacists.

Links to the PowerPoint Template, Conference Agenda, and Post-Test Question Upload are also below.

December 1st, 2024
Speaker Agreement Deadline

Speaker Agreement

2023 Veterinary Pharmacy Conference | June 1-3

Please submit this completed agreement. This agreement, made between the Speaker and the American College of Apothecaries, is effective until July 14, 2024.

"*" indicates required fields

1Speaker Information

2Presentation Information

3Requirements for CE Presenters

4Additional Sources

5Video/Audio Recording

6Post-Test Session Quiz Questions

7Policy of Non-Commercialism

8Presentation Materials/Guidelines

9Compensation/Reimbursement Policy

10Funds Disbursement

First and Last Name*

Degree*

RPh

PharmD

DVM

PhD

Other (answer below)

Other Degree

Job Title*

Company/Pharmacy/Organization*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Cell Phone*

Presentation Information

Speaker agrees to provide a presentation for the 2024 ACVP Veterinary Pharmacy Conference in accordance with the learning objectives and course description for the program. The speaker’s presentation must meet this criteria.

Please list presentation title and your name with credentials as you would like them in print:*

Needs Addressed / Activity Description*

Please provide a short (3-4 sentence) description of what need this presentation will address for pharmacists and/or pharmacy technicians.

How your presentation will lead to better business practices or veterinary care?

Please specify the intended audience. (150 words)

Which learning assessment component(s) do you plan to present?*

Knowledge-based CPE activity: These CPE activities should be designed primarily for pharmacists and technicians to acquire factual knowledge. This information must be based on evidence as accepted in the literature by the health care professions. *The Seminar will utilize informal audience response. Please reserve a brief question and answer segment at the end of your session.

Group Discussion

Case Studies

Observations

Fill-in activities

Paired practice (role playing)

Quizzes

Requirements for CE Presenters

The checklist below outlines information necessary for each presentation. This information complies with the Accreditation Council for Pharmacy Education (ACPE) standards. Please complete this checklist, along with your introductory bio and photo by the stated deadline.

Presentation Objectives - Pharmacists*

Please list 3-4 learning objectives for each session. Learning objectives must be consistent with the above activity type. Describe what the Pharmacists can expect to know or be able to do after completion of the CPE activity.
• Objectives are written in behavioral terminology and should suggest specific and measurable outcomes for an activity’s success or effectiveness. (Examples – Discuss, Describe, Identify, Compare, etc.)
• The following words should be avoided when writing learning objectives because they do not enable measurement: Be familiar with, Be aware of, Comprehend, Conceive, Figure out, Grasp, Handle, Imagine, Know, Learn, Master, Realize, Remember, Think, Understand
• For more assistance in writing SMART learning objectives, please refer to Bloom’s Taxonomy for Writing Learning Objectives.

Presentation Objectives - Technicians*

Please list 3-4 learning objectives for each session. Learning objectives must be consistent with the above activity type. Describe what the Technician can expect to know or be able to do after completion of the CPE activity.
• Objectives are written in behavioral terminology and should suggest specific and measurable outcomes for an activity’s success or effectiveness. (Examples – Discuss, Describe, Identify, Compare, etc.)
• The following words should be avoided when writing learning objectives because they do not enable measurement: Be familiar with, Be aware of, Comprehend, Conceive, Figure out, Grasp, Handle, Imagine, Know, Learn, Master, Realize, Remember, Think, Understand
• For more assistance in writing SMART learning objectives, please refer to Bloom’s Taxonomy for Writing Learning Objectives.

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Core Areas*

Which of these five core areas do you expect your presentation will address? (check all that apply)

Delivering Patient Care

Practicing Evidence-Based Medicine

Legislative & Regulatory Issues

Focusing on Quality Improvement

PR, Marketing & Social Media Strategies

Using Information Technology

Working as Part of Interdisciplinary Teams

Topic Designators – activities are related to:*

Which one of these eight areas do you expect your presentation will address?

01: Disease State Management/Drug Therapy - activities that address drugs, drug therapy, and/or disease states.

02: AIDS Therapy - activities that address therapeutic, legal, social, ethical, or psychological issues related to the understanding and treatment of patients with HIV/AIDS.

03: Law Related to Pharmacy Practice - activities that address federal, state, or local laws and/or regulations affecting the practice of pharmacy.

04: General Pharmacy- activities that address topics relevant to the practice of pharmacy other than those included in the classifications of drug/disease therapy related, HIV/AIDS therapy related, and law.

05: Patient Safety - activities that address topics relevant to the prevention of healthcare errors and the elimination or mitigation of patient injury caused by healthcare errors.

06: Immunizations - activities related to the provision of immunizations, i.e., recommend immunization schedules, administration procedures, proper storage and disposal, and record keeping. This also includes review for appropriateness or contraindication and identifying and reporting adverse drug events and providing necessary first aid.

07: Compounding - activities related to sterile, nonsterile, and hazardous drug compounding for humans and animals. This includes best practices and USP quality assurance standards, environmental testing and control, record keeping, error detection and reporting, and continuous quality improvement processes.

08: Pain Management - activities that address any component regarding the treatment and management of pain, including the prescribing, distribution and use of opioid medications, and/or the risks, symptoms, and treatment of opioid misuse/addiction.

99: Additional Topic Areas - activities related to topics relevant to the practice of pharmacy not included in the classifications of the topic designators 01-08.

Additional Sources

In addition to your PowerPoint presentation, please include at least 2 additional sources of educational materials as a means to enhance participant understanding of content and foster applications to practice (e.g. reference tools useful in practice, literature studies, informational guidance, key presentation “take home” points, supplemental handouts, etc.) Items may be uploaded.

Supplemental Handouts for Attendees

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 1 GB, Max. files: 6.

Video/Audio Recording

This educational session may be distributed by ACVP in an audio, visual or print format. ACVP may distribute your recorded presentation through ACVP and education partnership websites to attendees that wish to purchase the online recorded version. ACVP may syndicate any live and recorded presentation through third-party hosting sites, thereby offering this educational program via the ACVP Education Center online library. The recordings will be copyrighted and distributed by ACVP and their video/audiotape provider under Title 17 of the U.S. Code. All claims for royalties in conjunction with the sale of this webinar, DVD/CDs or handout materials are waived. No distribution of the recordings by anyone other than the ACVP or syndicated organizations will be permitted without your specific, prior permission. Your signature on this agreement represents your consent to the recording of your remarks and ACVP s right to copy and distribute them.

Video/Audio Recording Consent*

I Give My Consent

I Do Not Give My Consent

Post-Test Session Quiz Questions

We will be uploading the presentations as an online CE. Please include six (6) multiple choice and/or true/false questions that can be used as test questions. These questions can be submitted at this time or with your powerpoint presentation.
Please provide the correct answer in the box below the question.
New ACPE guidelines require learner feedback for quizzes. Please provide a one-sentence explanation for each response that demonstrates why that response is or isn't correct.

Question #1

Answer - Question #1

Question #2

Answer - Question #2

Question #3

Answer - Question #3

Question #4

Answer - Question #4

Question #5

Answer - Question #5

Question #6

Answer - Question #6

Policy of Non-Commercialism

The conference maintains a policy of non-commercialism in accordance with the American College of Apothecaries, which is the accrediting continuing education provider, in accordance with the Accreditation Council for Pharmacy Education, that states “Continuing pharmacy education activities that provide an in-depth presentation with fair, full disclosure as well as objectivity and balanced.

Appropriate topics and learning activities shall be distinguished from those topics and learning activities that are promotional or appear to be intended for the purpose of endorsing either a specific commercial drug or other commercial product (as contrasted with the generic product/drug entity and its contents or the general therapeutic area that it addresses), or a specific commercial service (as contrasted with the general service area and/or the aspects or problems of professional practice that it addresses).”

Presentation Objectives and Fair Balance Agreement

The American College of Apothecaries is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education and will be providing the accreditation for the educational programs developed at this seminar. To help us maintain compliancy with ACPE, please review the requirements below as well as the associated deadlines for submission.

Conflict of Interest Disclosure and Equitable and Fair Balance Agreement*

As a speaker and/or continuing education faculty member, I will:

a) ‘Meaningfully disclose’ any relevant interests that may affect the content of the educational activity being offered.
b) Identify and resolve all conflicts of interest prior to the educational activity being delivered to learners.
c) Ensure the content of the educational activity will give a balanced view of therapeutic options to promote improvements or quality in healthcare and not specific proprietary business interests of a commercial interest.

Balanced view means that recommendations or emphasis must fairly represent, and be based on, a reasonable view and valid interpretation of the information available in the subject and that no single product or service is over represented in the educational activity when other equal but competing products or services are available for inclusion.

We collect information from all planners, faculty, and others in control of educational content about all their financial relationships with ineligible companies within the prior 24 months. As defined by ACPE, an ineligible company is one whose those whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. There is no minimum financial threshold; individuals must disclose all financial relationships, regardless of the amount, with ineligible companies. Individuals must disclose regardless of their view of the relevance of the relationship to the education.

Exception: Accredited providers do not need to identify, mitigate, or disclose relevant financial relationships for accredited education that is non-clinical, such as leadership or communication skills training.

I agree to supply this information.

I have been informed that my presentation falls into the exemption above.

Download Financial Relationship Disclosure Form For Planners, Faculty, And Others

Financial Relationship Disclosure Form for Planners, Faculty, and Others*

Please upload your completed and signed financial Relationship Disclosure Form below.

Accepted file types: pdf, jpg, png, Max. file size: 200 MB.

Presentation Materials/Guidelines

Speaker agrees to provide ACVP with one (1) presentation of no more than 40 slides, per one hour session, to be included on the attendee website provided to meeting attendees. Please use the Official PowerPoint template provided to you to create your presentation. (See presentation guidelines below for additional formatting information.)

Securing permission for use within the slide presentation of any material under copyright is the speaker’s responsibility. Release and/or letters of permission, if required, shall be provided by the speaker to ACVP at the time slides are provided.

If you do not wish for your presentation to be included in the distribution to attendees for proprietary reasons, please submit your request in writing to donna@acainfo.org no later than thirty (30) days prior to the initial delivery of the educational program. Unless such a written request is received in the time specified, ACVP reserves the right to distribute the presentation in an Adobe Acrobat PDF format to all attendees in advance of or following the delivery of the educational program. The presentation must be sent to Donna Reagan at donna@acainfo.org on or before the stated deadline.

Distribution of presentation handouts after the due date will be the sole responsibility and expense of the Speaker. After the stated deadline, more information on providing your own presentation handouts will be provided to you if necessary. Please note, final presentation materials must be received no later than the stated deadline for review and reproduction for distribution to attendees. We are unable to accept any presentations after this deadline. (ACVP reserves the right to modify the handout and require re-submission to adhere to ACPE Guidelines).

*NOTE: There may not be an internet connection for presentations so we recommend that you do not include any links in your presentation where you would have to go “live” to a website.

Presentation Guidelines

Please follow these guidelines for developing and submitting your PowerPoint presentation:
1. Use the PowerPoint template provided to you.
2. Limit title fonts to Calibri Bold 44, black and text font to Arial Regular 28, black. Text should not be smaller than 18 points to be visible on the screen.
3. Submit handouts and PowerPoint presentations electronically.
4. Include supplement materials for future reference purposes (such as articles or sample forms)
5. Include a bibliography of related literature in your handout, especially if you refer to certain studies or publications in your presentation.
6. No commercial information of any kind is to be included in your handout.
7. No videos may be in your presentation.
8. Do not endorse specific compounding pharmacies or compounding copycat medications for economic reasons.
9. Do not suggest any specific cost comparisons that might be interpreted as collusion.

Introductory Bio

Please upload a brief paragraph format biography in a Microsoft Word document below. This biography will be used to introduce you during the program, included in the meeting syllabus to all attendees, and for promotional purposes to inform potential educational program participants.

Upload Your Bio*

Accepted file types: doc, docx, Max. file size: 250 MB.

Photograph Requested

To help us market and promote the conference, please upload an electronic photograph in .JPG or PNG format. This photo will be used in promotional material about the conference, on the web page, and onsite materials.

Upload Photograph*

Accepted file types: jpg, png, Max. file size: 1 GB.

Compensation/Reimbursement Policy

As a speaker, ACVP will provide you with compensation as described below provided that you submit a slide presentation for inclusion in the course syllabus by the stated deadline. Speaker must provide a completed W9 form and receipts in order for payment to be processed.

Under the terms of this agreement, speakers will receive compensation/reimbursement as follows:
• Meeting Registration, including CE & meals provided by conference
• Honorarium/Travel Reimbursement or Donation to the ACA Foundation
• Reimbursement for 1-night hotel accommodation at the host hotel, if applicable.

Please select one of the following options:

Download Request for Taxpayer Identification Number and Certification

W-9*

Please upload your completed and signed W-9 below.

Accepted file types: pdf, jpg, png, Max. file size: 200 MB.

Meeting Registration/Honorarium or Donation to the ACA Foundation*

Please select one of the following options:

$500 Honorarium plus one complimentary full registration with Continuing Education.

$500 Travel Reimbursement plus one complimentary full registration with Continuing Education.

$250 Honorarium/$250 Donation - plus one complimentary full registration with Continuing Education.

$500 Donation to the ACA Foundation on your behalf plus one complimentary full registration with Continuing Education.

Decline Honorarium but will accept a complimentary full registration with Continuing Education.

Other - See Speaker Agreement Amendment

Hotel Accommodations

ACVP will reimburse you for one night stay (room and tax only at standard conference room rate) at the conference headquarters hotel. The conference will be held at the SpringHill Suites Indianapolis Downtown. ACVP has reserved a block of rooms at this hotel.

Speakers will make their own reservations at the conference hotel and submit receipts to ACVP for reimbursement of the allowed expenses. This reimbursement is contingent upon receipt of your slide presentation by the stated deadline and will be included with your honorarium after the conclusion of the conference.

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I am:*

Please select all that apply.

an ACA Fellow

an ACA Pharmacist Member

an ACA Technician Member

an ACVP Fellow

an ACVP Pharmacist Member

an ACVP Technician Member

an ACVP or ACA Corporate Member

A PPHI Supporter

Not a Member

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Name Badge (First Name Only)

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I will attend the Welcome Reception - Thursday.*

Yes

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Cell Phone

I will need CE credit.*

Yes

I plan to attend the entire Conference.*

Yes

Conference Registration

Please fill out the information below to register yourself for the conference.

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My personal NABP eProfile ID

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My DOB (MMDD)

Arrival Date*

Departure Date*

Badge First Name*

I will arrive in time to attend Dinner with the Dolphins - Thursday, June 11, 2024 from 7:00 p.m. - 9:00 p.m.*

Yes

Cancellation

In the event the program is cancelled for which the Speaker has been hired, no compensation will be provided to the Speaker.

Funds Disbursement

ACVP agrees to disburse all monies due to the Speaker no later than 6 weeks after the conclusion of the conference.

The Speaker is an independent contractor and will pay all applicable state, local and federal taxes associated with this Agreement.

Due to ongoing issues mail security and delivery issues with the USPS, we offer electronic payment delivery. Speakers selecting this option should complete the attached Authorization for Direct Deposit Form and return it, along with an image of a voided check, to accounting@vetmeds.org.

Speaker requests that applicable compensation/reimbursement be made to:*

Make check payable to:

Method of Payment*

Physical Check

Direct Deposit

Download Authorization for Direct Deposit.

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Social Security # / Tax ID #:

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Productive Work Environment Policy

It is the policy of ACVP to promote a productive work environment and we will not tolerate verbal, physical or other conduct by an employee, agent, contractor, consultant, or representative of the Association that discriminates, harasses, disrupts, or interferes with another’s work performance or that creates an intimidating, offensive, or hostile environment.

Terms

I have read the terms of this Speaker Agreement between ACVP and myself for the 2024 ACVP Veterinary Conference, July 11-13, 2024 and agree to the terms presented. There are no other terms or conditions to my engagement other than those written here. There can be no changes unless agreed to in writing. Failure to complete this Speaker Agreement will result in the loss of compensation. Failure to comply with the handout requirements described in the Presentation Materials section above will also result in the loss of compensation.

Signed*

Type Full Name

Date*

MM slash DD slash YYYY

Phone

This field is for validation purposes and should be left unchanged.

May 15th, 2024
Presentation Deadline

Important Information

PowerPoint Template & Handouts

Download VPC Slide Template (.pptx)

Guidelines

Speaker agrees to provide ACVP with one (1) presentation of no more than 40 slides, per one-hour session, to be included on the attendee website provided to meeting attendees. Please use the Official Conference PowerPoint template provided to you to create your presentation (see presentation guidelines below for additional formatting information).

Securing permission for use within the slide presentation of any material under copyright is the speaker’s responsibility. Release and/or letters of permission, if required, shall be provided by the speaker to ACVP at the time slides are provided.
Presentation

Please follow these guidelines for developing and submitting your PowerPoint presentation:

Use the PowerPoint template provided to you.
Limit title fonts to Calibri Bold 44, black and text font to Arial Regular 28, black. Text should not be smaller than 18 points to be visible on the screen.
Submit handouts and PowerPoint presentations electronically.
Include supplement materials for future reference purposes (such as articles or sample forms).
Include a bibliography of related literature in your handout, especially if you refer to certain studies or publications in your presentation.
No commercial information of any kind is to be included in your handout.
No videos may be in your presentation.

All items may be emailed to donna@vetmeds.org.

Conference Agenda

Coming Soon!

Upload Session Quiz Questions

Speaker Agreement Q & A

We may use the presentations as an on-demand CE. Please upload six (6) multiple choice or true/false questions that can be used as test questions.

Name*
First Last
Your Email*
If we have any problems with your uploaded items, we will contact you at this email address.
Questions & Answers
We will be uploading the presentations as an online CE. Please include six (6) multiple choice and/or true/false questions that can be used as test questions.
Please provide the correct answer in the box below the question.
New ACPE guidelines require feedback for quizzes. Please provide a one-sentence explanation for each response that demonstrates why that response is or isn't correct.
Question - 1*
Answer - Question 1*
Question - 2*
Answer - Question 2*
Question - 3*
Answer - Question 3*
Question - 4*
Answer - Question 4*
Question - 5*
Answer - Question 5*
Question - 6*
Answer - Question 6*

Hotel

Please make your hotel reservations at the SpringHill Suites Indianapolis Downtown, 1601 West Washington Street, Indianapolis, IN 46204 using the link below:

Click here to make reservations for the Veterinary Pharmacy Conference 2024

$199+ tax per night

Conveniently located a 10-15 minute walk from the Indianapolis Zoo along the Central White River Trail. Enjoy the urban greenspace and cultural amenities of the White River State Park as you stroll across the pedestrian bridge.

The Conference room rate is guaranteed to be available until June 20, 2024.

Note: A credit card is required to guarantee the reservation, however, a deposit is not charged. Attendees may cancel their reservation for no charge before 11:59 P.M. local hotel time 48 hours prior to arrival. Please note that cancellation fees will be charged after this deadline.

Need Help?

For assistance with conference registration, contact the ACVP Office at 901.383.1781 or donna@vetmeds.org (preferred).

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REGISTER

SCHEDULE JULY 11-13, 2024

ATTENDEE INFORMATION

HOTEL + EXTRAS

SPONSOR & EXHIBIT

ACVP Veterinary Pharmacy Conference – Speaker Agreement and Information

Speaker Agreement

2023 Veterinary Pharmacy Conference | June 1-3