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    Forms & Templates

     

    Disclosure Form
    * Due by June 25

    This form must be completed by ALL Conference presenters, as well as Conference Planning Committee members.

    CFHA-2010-Conference-Financial-Disclosure-Form

     

    Powerpoint Template
    * Due by September 1

    All presentations must be submitted to CFHA by September 1 for advance review and content approval by CE Central. A PowerPoint outline has been included as a guide; we ask that your first five slides please follow this layout. The background is your choice.

    CFHA-2010-Conference-Powerpoint-template

     

    Presenter Details

     

    Remaking National Healthcare
    Collaborative Care for a Healthier America

     

    CFHA 12th Annual Conference

    October 21-23, 2010

    The Seelbach Hilton Hotel, Louisville, Kentucky U.S.A.

     

     

    Preliminary Agenda for Breakout Sessions


    (subject to change)

     

    Selected Poster Presentations

    Selected-Poster-Presentations

     

    Selected Discussion Groups

    Selected-Discussion-Groups

     

     

    A confirmation email will be sent to the Primary Contact Person for each proposal.

     

     

    PRESENTER CONFIRMATION DETAILS

     

    Thank you for submitting a proposal and agreeing to present at the Collaborative Family Healthcare Association 12th Annual Conference to be held October 21-23, 2010. The Conference will be held at The Seelbach Hotel, 500 Fourth Street, Louisville, Kentucky 40202-2518, USA.

     

    The Primary Contact Person for your presentation agrees to receive all correspondence and accepts responsibility for conveying and confirming Conference-related information with co-presenters.

     

    CE Central, a unit of the University of Kentucky Healthcare, will be accrediting CFHA Conference sessions for CME and CPE credit. In accordance with the policies of the Accreditation Council for Continuing Medical Education (ACCME) and the Accreditation Council for Pharmacy Education (ACPE), CE Central requires that all presenters must provide ALL of the following information for sessions to be eligible for CME and CPE credit.

     

    Please respond according to the required deadlines noted below.

     

    Due by June 25, 2010


    1. Signed Presenter Agreement form. Please confirm the presentation title and individuals who will attend and present this session at the CFHA Conference. This form may be signed by primary contact on behalf of all presenters.

     

    2. CV or resume for each presenter. This may have been submitted with your online presentation proposals. If you have made changes or additions to the list of presenters for this session, please provide a CV for each new presenter.


    3. Disclosure of Financial Interest form. Each presenter and co-presenter must complete, sign and return this form.


    4. Measurable Behavioral Objectives for each session. Please confirm that the learning objectives submitted with your presentation proposal are complete. The first word must contain an action verb, such as Identify, List, Describe; avoid subjective words like Learn, Understand and Explore.


    4. Five (5) Post-Test Questions for each session. Participants will be required to complete an online post-test to earn credit and print CME certificate.

     

    Due by September 1, 2010

     

    1. Powerpoint Presentation. CE Central must conduct an advance review of all session content to determine that the session is eligible for CME credit and does not contain commercial bias. A PowerPoint template is attached; please use CFHA's format for the first five slides.

     

    2. Handouts. CE Central must review and approve all content in advance. You may not distribute printed handouts at the Conference unless content is approved by CFHA in advance.

     

    3. Permission required to publish approved PowerPoint presentations on the CFHA web site as a resource for Conference attendees.

     

    If you do not comply with the above requirements and deadlines, CFHA reserves the right to cancel this session for the 2010 CFHA Conference.

     


     

     

    Disclosures of Financial Interest Form: Due June 25, 2010 * REQUIRED FOR CE ACCREDITATION *

     

    Commercial Support Standards require that the activity be free from commercial bias and not promote any particular product. Any information regarding commercial products/services is based on scientific methods generally accepted by the medical community. We request that you use generic names when referring to any pharmaceutical product or mention several manufacturers when referring to products.

     

    Also, please be sure to inform the audience if you mention any non-label use of a product. Be sure to designate any product brand names with the trademark ® symbol.

    All presenters and co-presenters must read, complete, and sign the enclosed Disclosure of Financial Interest form and return by June 25, 2010. This data will be used to ensure that your involvement in this activity is monitored for bias and/or lack of content balance. Detailed faculty disclosures will be included in participant materials or given prior to presentations.

     

    Post-Test Questions: Due June 25, 2010 * REQUIRED FOR CE ACCREDITATION *

     

    Participants will be required to complete an online post-test to earn CME credit for the CFHA Conference. Please submit five (5) questions to be used for this purpose.

     

    Audio-Visual and Classroom Set-up: Special Requests Due June 25, 2010

     

    Each classroom will be equipped with a lectern and microphone, a PC laptop computer, an LCD projector and screen. One small table will be available for instructor use. Please note that you will not be able to plug-in your own computer to the projector.

     

    Classrooms vary in size and capacity and will be set in theatre-style (chairs only) to maximize seating. A schedule with meeting room assignments will be provided to you at the Conference. Plan to arrive at your classroom at least 30 minutes prior to the start time.

     

    CFHA may consider additional setup or equipment requests, but does not guarantee availability or provision for such requests due to the overall needs of the CFHA Conference.

     

    PowerPoint Presentations: Due September 1, 2010 * CONTENT REVIEW REQUIRED FOR CE ACCREDITATION *

     

    Each classroom will be equipped with a PC laptop computer and an LCD projector. The Conference AV team will pre-load your PowerPoint presentation onto the classroom computer in advance.

     

    PowerPoint presentations must be emailed to steffani@ascentmeetings.com later than September 1, 2010. All presentations must be reviewed in advance by CE Central for CME content approval.

     

    A PowerPoint outline has been included as a guide; we ask that your first five slides please follow this layout. The background is your choice.

     

    Please keep in mind that educational materials that are part of a CME activity, such as slides, abstracts and handouts, cannot contain any advertising, trade name or a product-group message.

     

    Handouts: Due September 1, 2010 * CONTENT REVIEW REQUIRED FOR CE ACCREDITATION *

     

    CFHA Conference attendees often express the need for handout materials related to conference sessions. In lieu of printed handouts, CFHA offers electronic options to these resources through its web site. The best format for handout material is a detailed outline of your lecture so that note taking can be kept to a minimum.

     

    ACCME guidelines require that educational materials that are part of a CME activity, such as slides, abstracts and handouts, cannot contain any advertising, trade name or a product-group message.

     

    Presenters must provide handout materials, a class outline and/or any other related resources to CFHA by September 1 so that these can be made available to attendees PRIOR to the Conference. Documents should be submitted electronically in PDF or Word format to steffani@ascentmeetings.com.

     

    Permissions Required: Due September 1, 2010

     

    [__] Yes, I/we give consent to CFHA to publish the approved PowerPoint presentation for this session on the CFHA web site as a resource for CFHA Conference attendees.

     

    [__] No, I/we DO NOT consent to having CFHA to publish the approved PowerPoint presentation for this session on the CFHA web site as a resource for CFHA Conference attendees.

     

    Conference Registration Required: Register by September 1, 2010

     

    All Presenters must register and pay to attend the CFHA Conference. Early bird registration fees for the 2010 CFHA Conference are $395 for CFHA members, $435 for non-members; one-day registrations are $200 and up. Online registration will open in June 2010 at www.CFHA.net.

     

    Presenters are responsible for their own travel and hotel arrangements and assume all related costs.

     

    Accommodations should be reserved at the designated CFHA Conference hotel, The Seelbach Hilton. CFHA group rate of $130 (single or double occupancy) is available for reservations made before September 1. Call The Seelbach Hilton for reservations at 1-800-333-3399.

     

    AGREEMENT COMPLETION

     

    By agreeing to present at the CFHA Conference, all presenters confirm that:


    • All presenters agree to provide the required information outlined above according to CFHA's deadlines.
    • Appropriate "Releases of Confidential Information" have been obtained for all client materials and copyrighted materials that will be used or recorded as part of this presentation. The responsibility for protecting client confidentiality rests with the Presenters.
    • For presentations involving research with human subjects, all Presenters confirm and assume responsibility that the research has received approval from the appropriate institutional review board and the data has been collected in an ethical manner.
    • All Presenters agree to be photographed, videotaped, broadcast and/or recorded by the Collaborative Family HealthCare Association, or any supplier contracted by CFHA. CFHA or any supplier contracted by CFHA shall own all rights of any kind in perpetuity in said photography, videotaping, broadcast and/or recording.
    • Conference sessions are intended for educational purposes and are noncommercial forums. Presenters should refrain from specific product endorsement whenever possible and under no circumstances should the session be used as a place for direct promotion of a presenter's product, service or monetary self-interest.
    • CFHA reserves the right to cancel an activity for any reason prior to the activity and will notify you as soon as a decision has been made to cancel.

     

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