Department of Continuing Medical EducationThe Annual Pediatric Postgraduate CourseSPEAKER CONFIRMATION FORM Please complete the following form as soon as possible so that we may adequately prepare for your presentation Presentation Details Presentation Title * Presentation Date * Select the date your presentation is scheduled for Saturday, April 2, 2022 Sunday, April 3, 2022 Learning ObjectivesPlease provide at least 3 learning objectives for your presentation. Objective 1 * Objective 2 * Objective 3 * Add additional objectives? Select this option to add a fourth or more objectives. Make sure to number any additional objectives. Yes Objective 4+ * I plan to include the following elements in my presentation: * (Select all that apply) Video Playback (Video only, including animated gifs, YouTube videos, or other videos embedded in my presentation) Video with Audio Playback (Video including audio meant for the audience to hear) None of the above Other (please describe)... I plan to include the following elements in my presentation: Other (please describe)... Would you like us to tag you directly on our social media advertisement campaign? * Information for this year's Pediatric Postgraduate Course talks will be shared across Twitter, Instagram, and Facebook. The posts will advertise the talk's title and speaker. Let us know if you'd like to be tagged in any of our posts. If yes, please enter at least ONE of your social media handles. (If you do not have any social media accounts, we will still mention you by name) Yes No Twitter Instagram Facebook Speaker Contact InformationAll speakers will be expected to participate in the live Q&A session via zoom, taking place after their session airs. These Q&A sessions will range between 5-15 min depending on the presentation block and the date/time is included in your invitation letter. Please provide a phone number where we can reach you on the day of the conference. This number will be used for emergencies only in the event you fail to connect at the scheduled time, or need to be reached out to trouble-shoot your connection. You can also provide alternate emails for us to send you speaker documentations, reminders, and/or other communications. Phone Number * Alternative Email Speaker Agreement Confirmation By entering my name below I agree to submit my slides no later than 24 hours before my scheduled recording session and complete any requested forms via the iLearnPeds.com platform. * email * If you are logged in, your iLearn profile 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 your account Leave this field blank
