Agreement – ACP-New Jersey Chapter

SPEAKER LETTER OF AGREEMENT

This agreement is made between the American College of Physicians New Jersey Chapter (ACP-NJ) and the below signed presenter and serves to confirm participation as a speaker for the American College of Physicians New Jersey Chapter Annual Scientific Meeting on May 13, 2022.

Presentation Title *

Personal Information:

Presenter's Name *

First

Last

Professional Title: *

Organization: *

Street Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Day of Contact Phone Number: *

Production Timeline:

Deliverable Deadlines:

Speaker Letter of Agreement Form Completed, Signed, and Submitted - Tuesday, March 15 2022
Faculty Full Disclosure Form Completed, Signed, and Submitted - Tuesday, March 15, 2022
Brief Session Description - Tuesday, March 15, 2022
Brief Bio and Headshot - Tuesday, March 15, 2022
Three (3) Learning Objectives - Friday, March 25, 2022
Three (3) Post-Test Questions, One (1) MOC Question - Friday, March 25, 2022
First Draft of PPT Presentation (on ACP slide deck template provided) - Friday, April 15, 2022
Final PPT Presentation Due (on ACP slide deck template provided) - Friday, April 29, 2022

Agreement:

Please initial to indicate your agreement with the following statements:

Faculty Declaration of Full Disclosure: All speakers must make a statement of full disclosure of financial conflicts of interest. Completed and signed disclosure statements must be received by staff no later than the date listed above. *

Review of Educational Materials: In accordance with ACCME requirements, all educational materials including slide presentations must be reviewed by the CME Department or Planning Committee. To ensure time for review and revisions (if necessary), draft materials must be submitted no later than the date listed above. *

Release of Materials: Speaker provides authorization to post his/her slides and/or handouts for attendees. Speaker affirms that all necessary approvals allowing reproduction of materials have been attained. It is suggested that the speaker protect his/her material with a copyright by putting the following language on the bottom of the first page: © 2022 BY (SPEAKER NAME). The ACP-NJ takes no responsibility for registering the speaker’s copyright and advises the speaker to take all appropriate steps to do so. *

Photographic Release: Speaker grants the ACP-NJ permission to use their likeness in photograph(s)/video in any and all publications, whether in print or electronically and in all other media, whether now known or hereafter existing, controlled by the ACP-NJ. The Speaker will make no monetary or other claim against the ACP-NJ for the use of the photograph(s)/video. *

Speaker Information: If requested, speaker will provide a CV, bio sketch and/or headshot (high resolution JPEG file) to be used for planning and publicity. These files will be provided to staff no later than the date listed in the production timeline. *

Date