Webinar Speaker Agreement - American College Veterinary Pharmacists

Please submit this completed agreement. This agreement is made between the Speaker and the American College of Veterinary Pharmacists.

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Speaker Information
First and Last Name*
Degree*
- RPh
- PharmD
- PhD
- MD
- DVM
- Other (answer below)
Other Degree
Company/Pharmacy/Organization*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Fax Number*
Date of Webinar*
We recommend a Tuesday, Wednesday or Thursday.
Time of Webinar*

: HH

MM
Policy of Non-Commercialism
ACVP 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 balance.

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).”
Checklist 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, photo and your Conflict of Interest Disclosure within 10 days of receipt of this agreement.
Presentation Information
Speaker agrees to provide a webinar presentation for the ACVP in accordance with the learning objectives and course description for the program. The speaker’s presentation must meet with this criteria.
Please list presentation title and your name with credentials as you would like them in print:*
Presentation Objectives*
Please list 3-4 learning objectives for your webinar. Learning objectives must be consistent with the above activity type. Describe what the Pharmacists and/or Technician can expect to know or be able to do after completion of the CPE activity. Objectives are preferably written in behavioral terminology and should suggest specific and measureable outcomes for an activity’s success or effectiveness.

You will be evaluated by attendees based on the below objectives:
Activity Description*
Please provide an activity description of how your presentation intends to create changes in behavior that will lead to better business practices or patient care for pharmacists and technicians.
Supplemental Handouts for Attendees
Accepted file types: doc, docx, pdf.
On-Demand CE
Please include three (3) multiple choice questions that can be used as test questions. Please provide the correct answer in the box below the question.
Question #1*
Answer - Question #1*
Question #2*
Answer - Question #2*
Question #3*
Answer - Question #3*

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Presentation Materials/Guidelines
Speaker agrees to provide the ACVP with one (1) presentation of no more than 30 slides, per one hour session, to be included on the attendee website provided to meeting attendees. Please use the Official ACVP Education CEnter PowerPoint template provided to you by ACVP to create your presentation. (See presentation guidelines below for additional formatting information.)

Speaker also agrees to provide slides in the following format:
• PowerPoint attachment sent via email to Linda Cathey at membership@vetmeds.org.
• ACVP is unable to accept documents in Macintosh format.

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.

Please note, final presentation materials must be received no later than 2 weeks prior to the webinar date.
Introductory Bio
Please provide a brief paragraph format biography in a Microsoft Word document within 10 days of receipt of this agreement. This biography will be used for promotional purposes to inform potential program participants.

Upload your bio below or email your biography to Linda Cathey at membership@vetmeds.org.
Upload Your Bio
Accepted file types: doc, docx.
Photograph Requested
To help us market and promote the webinar, we would like faculty to provide an electronic photograph in .JPG or .PNG format. This photo will be used in promotional material about the webinar, on the web page, and onsite materials. Please submit a photo for use within 10 days of receipt of this agreement. The photo may be uploaded below or emailed to Linda Cathey at membership@vetmeds.org.
Upload Photograph
Accepted file types: jpg, png.
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 webinar. The American College of Veterinary Pharmacists programming is co-sponsored by the American College of Apothecaries.

To help us maintain compliancy with ACPE, please review the requirements below as well as the associated deadlines for submission. Please email the fair balance form directly to Linda Cathey at membership@vetmeds.org or fax it to (901) 383-8865.
Compensation/Reimbursement Policy
Under the terms of this agreement, speakers will receive compensation as follows:

• $250 Honorarium per 1-hour webinar

A signed copy of this Speaker Agreement must be submitted to Linda Cathey at membership@vetmeds.org within 10 days of the email. Failure to return this Speaker Agreement will result in the delay and/or loss of compensation.
Cancellation
In the event the webinar is cancelled for which the Speaker has been hired, no compensation will be provided to the Speaker.

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Funds Disbursement
ACVP agrees to disburse all monies due to the Speaker no later than 6 weeks after the conclusion of the Webinar.
Speaker requests that applicable compensation/reimbursement be made to:*
Make check payable to:
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.
Conflict of Interest Disclosure and Equitable and Fair Balance Agreement
You will receive a link to download the Conflict of Interest Disclosure and Equitable and Fair Balance Agreement, in your confirmation email, after you submit your speaker agreement. Please email or fax back to Linda Cathey at membership@vetmeds.org or 901-383-8865.
Terms
I have read the terms of this Speaker Agreement between ACVP and myself for the Webinar 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*

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Step 1 of 3

Speaker Information

Policy of Non-Commercialism

Checklist for CE Presenters

Presentation Information

On-Demand CE

Presentation Materials/Guidelines

Introductory Bio

Photograph Requested

Presentation Objectives and Fair Balance Agreement

Compensation/Reimbursement Policy

Cancellation

Funds Disbursement

Productive Work Environment Policy

Conflict of Interest Disclosure and Equitable and Fair Balance Agreement

Terms