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. Presentation Details Select your Upcoming Activity * -Select-Pediatric Grand RoundsFaculty DevelopmentPractical Community Pediatrics SessionPediatric Postgraduate CourseGeneral Ped. Review & Self-AssessmentPed. Hospital Medicine Review & Self-AssessmentHuman Growth Foundation Conference 2022Other (enter series/activity title)... Select your Upcoming Activity Other (enter series/activity title)... Date of your presentation * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202320242025 Presentation Title/Topic * Select your presentation format * - I will be presenting... - Live and in person (in front of a live audience) Live in a virtual setting (via a virtual meeting platform, like Zoom) 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 Playback (music or video sound) Video Playback (video only) Audience Response System (Poll Everywhere, Kahoot, or other) Web Browser Access Presentation method other than PowePoint 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 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 reg. 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 CategoriesPlease select AT LEAST ONE category below. Users can use the following categories to filter and find relevant sessions when searching for available activities in our course search. 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 at least 72 hours before my session 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
