Speaker Waiver Form

For accreditation and session success, your completion of this waiver form is mandatory for EACH CME&PD event you moderate/speak/facilitate or are an author for.

Full Name

Email Address

Date(s) of Course

Presentation(s) Title(s)

Session Requirements

If your session will be online via Zoom, you will need to have a computer or tablet with access to the internet with both audio and video capabilities including headphones, a microphone and a webcam in order to present. For system requirements, you can visit https://support.zoom.us/hc/en-us/articles/201362023-System-Requirements-for-PC-Mac-and-Linux

In-person or Virtual Session: I have a video/audio component in my presentation (such as podcast, embedded recording in presentation)

Yes

My session will have

Break out rooms

Polls

Animations

None of the Above

Other…

(Please inform us at least three weeks ahead of time)

For hands on skills sessions or demonstrations, please specify any additional requirements, such as medical supplies or equipment and be as specific as possible, such as product name, model:

Short biography - to emphasize your expertise, training and essential details about yourself to course participants

Accreditation Letter and Registration to the course

As faculty, you are offered complimentary registration. When you are registered to the program you will receive access to all sessions, handouts, and the accreditation letter.

*Once you are registered, you will receive an email the day before the event with instructions on how to access the conference page and on how to get your accreditation letter after the event.

Do you want to be registered for the course?

Yes - you will receive further communication from the CME&PD office

CME & PD TERMS AND CONDITIONS - YOUR COURSE CONTENT

1. Handouts: The handout materials that I provide for the program may be printed to be distributed to course registrants,

2. Presentation: My presentation and my person may be recorded in podcast, audio, video or still image format, and

3. That both 1 and 2 may be posted to a password-protected site managed by the CME & PD Office for the exclusive use of course registrants for a period of up to 12 months following the date of the program.

I agree to the terms outline above:

Yes

AGREEMENTS & SIGNATURE

I will ensure that I am compliant with, and will use copyright-protected materials in accordance with, the University of Calgary copyright policy, Acceptable Use of Material Protected by Copyright. Furthermore, I understand that the Copyright Office (copyright@ucalgary.ca) is available to offer guidance, should I need assistance with this.

I consent to participate in the program or project identified above. I understand that the information collected will be used only for the purposes listed above. If I have any questions about the collection or use of this information, I will contact the CME & PD Office. I certify that I have read and fully understand this Waiver and that all questions pertaining to this Agreement have been answered to my satisfaction.

Name

Signature

Sign above

Date

Collection of personal information
Your personal information is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of this information, please visit our Access to Information page.