Department of Continuing Medical EducationSpeaker Confirmation FormThank you for agreeing to participate in one of our accredited Continuing Medical Education activities. Complete the form below as soon as possible so that we can prepare for your session. Select your Upcoming Activity * -Select-Faculty Development SeriesPractical Community Pediatrics SessionOther Regularly Scheduled SeriesThe Annual Pediatric Postgraduate CourseThe General Pediatric Review & Self-Assessment CourseThe Pediatric Hospital Medicine Review & Self-AssessmentThe Human Growth Foundation Education DayOther (enter series/activity title)... Select your Upcoming Activity Other (enter series/activity title)... Presentation Details Date of your presentation * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026 Will you use the same presentation as last year? * - Select - Yes, please send me a copy for review Yes, same file with no edits. No, I will be submitting a new set of slides (no later than 05/15) Presentation Title/Topic * Select your presentation format * - I will be presenting... - In person (in front of a live audience) Virtually (via a virtual meeting platform, like Zoom or MS Teams) Pre-recorded video Learning ObjectivesList a minimum of three (3) learning objectives in terms of: "At the conclusion of this activity, participants should be able to…" Objective 1 * Objective 2 * Objective 3 * Additional objectives? Yes Objective 4+ * Enter any additional objectives below, separated by periods or numbers. Presentation Accommodations My presentation will require/include... * Audio or Video Playback (music or video with/without sound) Audience Response System (like PollEverywhere, or other) Gamification System (like Kahoot, or other) Web Browser Access Presentation platform other than PowerPoint ( like Google Slides or Canva) Other... My presentation will require/include... Other... My virtual presentation will require/include... * Polling (Via Zoom) Polling (Via Poll Everywhere) Break Out Rooms (Via Zoom) Gamification (Kahoot, etc.) Video/Audio Playback Other... My virtual presentation will require/include... Other... I will need the following when recording my presentation... * Assistance with Zoom set-up/installation Recording to be scheduled outside regular business hours (M-F, 8am -5pm EST) A quiet location to record (unable to record in the office or at home) Other... I will need the following when recording my presentation... Other... Presentation CategoriesUsers can use the following categories to filter and find relevant sessions when searching for available activities in our course search. Please select AT LEAST ONE category below as it relates to your presentation. Categories * Adolescent Medicine Allergy and Immunology Anesthesiology Child Abuse Pediatrics Child Life Dermatology Developmental-Behavioral Pediatrics Family Medicine General Pediatrics Hospice & Palliative Care Medical Genetics Medical Toxicology Neonatal-Perinatal Medicine Neurological Surgery Nursing Nutrition Obstetrics and Gynecology Occupational Therapy Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatric Cardiology Pediatric Critical Care Medicine Pediatric Dentistry Pediatric Emergency Medicine Pediatric Endocrinology Pediatric Gastroenterology Pediatric Hematology-Oncology Pediatric Hospital Medicine Pediatric Infectious Diseases Pediatric Nephrology Pediatric Neurology Pediatric Pulmonology Pediatric Rheumatology Pediatric Transplant Hepatology Pharmacy Physical Medicine and Rehabilitation Physical Therapy Plastic Surgery Preventive Medicine Psychiatry Psychology Radiology Research Risk Management Sleep Medicine Speech Therapy Sports Medicine Surgery Thoracic Surgery Urology COVID-19 Speaker AttestationBy entering my name below I agree to submit my presentation slides before the deadline stated in my faculty invitation email and complete any requested forms via the iLearnPeds.com platform or otherwise. * name * email * Your iLearn user email will be entered as default. If you are not logged in or do not have an iLearnPeds.com account yet, please enter the email you intend to use when registering. Leave this field blank
