Call for Papers - MSHA CE Events
* Presenter Name
0/50
* Presenter Email Address
0/50
* Address and Phone Number
0/250
* Indicate which event you would like to be considered a speaker for?
0/250
 
* Presenter (2)
0/50
Email Address
0/50
* Address
0/250
* Phone Number
0/50
* Are you willing to allow MSHA to record your presentation and make it available on-demand following the event? Estimated on-demand window would be 3 months.
* Honorarium Requested
* If you are requesting an honorarium what is the amount?
0/250
* Other Fees Requested (travel, meals, lodging if event is in-person)
* If you are requesting additional expenses covered what is the amount and expense?
0/250
* Title, Length and Instructional Level of the Presentation
0/250
* Presentation Abstract
0/500
* Each presentation must have a minimum of three course objectives/learner outcomes and your presentation must reflect these outcomes.
0/500
Speaker Bio: Please detail your bio. If your presentation is selected this bio will become available to attendees and presented at the conference.
0/500
* Program Planner Instructional Personnel's Name
0/50
* Course Title
0/250
* Signature and Date
0/50

Financial and Non-Financial Relationship Disclosure Form

For Program Planners and Instructional Personnel



In compliance with American Speech-Language Hearing Association’s Continuing Education Board’s Requirements, the Maryland Speech-Language-Hearing Association requires program planners and instructional personnel to disclose information regarding any relevant financial and non-financial relationships related to course content prior to and during course planning.  


Based on the information provided, the CE Administrator or a designated Board Member will engage the program planner/instructional personnel in a guided interview process which seeks to understand how the relevant financial or nonfinancial relationship may influence the content of the course.  
* Financial Relationship Disclosure Form (As it relates to MSHA) - Choose each relevant financial relationship. Program Planners/Instructional personnel have a relevant financial relationship if that relationship could influence the information presented in the course and could be perceived as a conflict of interest by learners.
List Other Financial Disclosures Here:
0/250
* Do you have any non-financial disclosures? If yes, please include the information below.
List Non-Financial Disclosures Here:
0/250
Submit Survey
If you just opted in, you're consenting to receive marketing emails from: Maryland Speech-Language-Hearing Association, 140B Purcellville Gateway Drive, Suite 120, Purcellville, VA 20132. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact