D.O. CME Speaker Agreement Template

2015 H Street
Sacramento, CA 95811
Phone: (916) 822-5246
Fax: (916) 822-5247
Name of Program:
25th Annual Fall Conference
Location of Program:
Monterey Plaza Hotel * Monterey, CA
Dr. Name,
On behalf of the 2014 Fall Conference Program Chair and the 2014-2015 Education Committee, I am very pleased to
confirm your speaking engagement at OPSC’s 25th Annual Fall Conference at the Monterey Plaza Hotel in Monterey, CA.
The following pages contain information and responsibilities for your participation and important deadlines for
submission of materials. Please review them carefully. Page two should be completed and returned to me as soon as
Your presentation is scheduled for Friday, September 12, 2014 from 5:30 – 6:30pm.
Should you have questions regarding the contents of this document, please do not hesitate to call me or email.
Karl Baur, CMP, CGMP
Director, OPSC Meetings & Publications
Ph: 916.822.5246
Email: meetings@opsc.org
Agreement Acceptance for: NAME
Overview Info:  My presentation title (Page 3) is correct.
 I have a new/revised presentation title – noted on Page 3
 My contact information (Page 3) is correct.
 I have changes to my contact information – noted on Page 3
Honorarium: 
I will waive my honorarium in support of OPSC and the osteopathic profession
I would like to receive a complimentary registration in lieu of an honorarium
I would like to receive the standard honorarium of $250.
I have an alternate request (requires approval by OPSC): __________________________________
Audio/Video Recording: OPSC may record your presentation for online streaming and/or future on-demand access.
 I authorize OPSC to record my presentation as indicated above.
 I do not give permission to record my presentation as indicated above.
Audience Response System:
 I would like to use the Audience Response System
 I will set up my own Turning Point 5 slides
 I would like OPSC to set up my slides for the Audience Response System
 I do not intend to use the Audience Response System
 I have no actual or potential conflict of interest in relation to this program or presentation.
 I have a financial interest/arrangement or affiliation with one or more organizations that could be
perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
Affiliation/Financial Interest
Grant/Research Support
Speakers' Bureau
Major Stock Shareholder
Other Financial / Material Support
Please note that all required documentation must be provided prior to your presentation.
If documentation is missing you will forfeit agreed upon honorarium and/or any reimbursement due to you.
To accept the contents of this Agreement, please sign below.
Speaker/Presenter: NAME
Please sign and return to the OPSC office ASAP to confirm your participation
Attn: Karl Baur, CMP, CGMP - Director, Meetings and Publications
Phone: (916) 822-5246  Fax: (916) 822-5247  Email: meetings@opsc.org
Agreement Contents
Section I:
Section II:
Section III:
Section IV:
Section V:
Section VI:
Section VII:
Continuing Medical Education Requirements
Speaker Compensation
Audio-Visual Equipment
General Information
On the Day of Your Presentation
OPSC Fall Conference Documents
Page 3
Page 3
Page 5
Page 5
Page 6
Page 6
Page 7
Page 8
Section I: Overview
Presentation Information (for Publishing)
Speaker Contact Information (for OPSC Use Only)
Email: EMAIL
Preferred Phone: PHONE
Alternate Phone: PHONE
 Cell
 Cell
 Office
 Office
 Home
 Home
Section II: Continuing Medical Education (CME) Requirements
All required documentation must be provided prior to your presentation.
If documentation is missing you will forfeit agreed upon honorarium and/or any reimbursement due to you.
SPEAKER agrees to abide by all deadlines in order to meet criteria for CME approval.
A. Supplemental Materials: Each Speaker is required to submit supplemental materials to enhance his/her
presentation. Submitted materials will be printed in the conference syllabus and/or posted on the OPSC
web site as noted below unless otherwise arranged with OPSC. All supplemental material(s) not reproduced
by OPSC must be approved prior to distribution and becomes the expense and responsibility of the speaker
to copy and ship onsite. (All pre-published article submissions will require a signed copyright release from
the publishing entity.)
Educational Objectives – Due July 16, 2014
Please provide 3-5 Learning Objectives for your session. These will be published in the
Conference Syllabus.
Self-Assessment Questions – Due July 16, 2014
Please provide 7-10 multiple choice Self-Assessment questions for your presentation. Since
OPSC intends to use an Audience Response System in conjunction with the Conference, 3-5
of your questions will be inserted into your slides (immediately following your title slide) to
serve as a session pre-test. All of the questions will be listed in the Conference Syllabus.
Session Description – Due July 16, 2014
Please provide a 1-2 paragraph description of your presentation. The description you provide
will be used for informational and marketing purposes.
Biographical Information & CV – Due July 16, 2014
The biography you submit will be published in onsite materials and used to introduce you prior
to your presentation. OPSC reserves the right to edit your submission to fit the space or time
available. Your CV is required for our CME documentation and is not published.
Presentation Materials – Due July 16, 2014
Please provide an outline or PowerPoint of your presentation and/or any pertinent materials for
inclusion in the program syllabus and online publication. Please include source references on
your slides for data included in your presentation. Materials should be limited to no more than
50 pages and can be submitted by email (to: meetings@opsc.org) or by uploading to
yousendit.com by using this URL:
We strongly recommend that you also bring a backup copy of your presentation with you on a
USB/Flash Drive. In the event that you have made revisions to your presentation after
submission to OPSC, we will be able to load your revised presentation onsite. Please allow
extra time if you plan to bring a revised presentation.
B. Faculty Disclosure Policy: It is the policy of OPSC to ensure balance, independence, objectivity, and
scientific rigor in all its individually sponsored or jointly sponsored programs. All faculty participating in
any OPSC sponsored programs are expected to disclose to the program audience any real or apparent
conflict(s) of interest that may have a direct bearing on the subject matter of the continuing medical
education program. This pertains to relationships with pharmaceutical companies, biomedical device
manufacturers, or other corporations whose products or services are related to the subject matter of the
presentation topic. The intent of this policy is not to prevent a speaker with a potential conflict of interest
from making a presentation. It is merely intended that any potential conflict should be identified openly so
that the listeners may form their own judgments about the presentation with the full disclosure of the facts.
It remains for the audience to determine whether the Speaker's outside interests may reflect a possible bias
in either the exposition or the conclusions presented. Any disclosures you may have to report (or
declaration of “no disclosures”) should be included on the Speaker Acceptance Form (Page 2).
C. Disclosure of Unlabeled / Investigational Uses of Products: Audience must be made aware of products
not yet approved/under review/investigation if said product(s) are addressed during the presentation.
D. Product Promotion: At no time during any lecture is there to be favoritism given to one drug or
pharmaceutical company or promotion of any product(s) personally used or provided by Speaker.
Arrangements may be made for promotion of product(s) during OPSC’s Exhibit Hall hours (an exhibit fee
may be required). Please contact Karl Baur, CMP, CGMP, Director, Meetings and Publications at the
OPSC office or by email at meetings@opsc.org for promotional and/or exhibiting opportunities.
E. Miscellaneous: Details and manner of speech are under the control of the Speaker. However, OPSC
prohibits the use of profanity or any use of speech that would be construed as offensive, derogatory or in
poor taste during your presentation. Further, the ideas and opinions expressed in your session, and in any
handout materials provided, are those of the Speaker and not of OPSC. Finally, Speaker agrees to hold
harmless and indemnify OPSC for any claims made, including copyright violations, arising from Speaker
remarks or handouts.
Section III: Speaker Compensation
A. Honorarium/Complimentary Registration: OPSC offers Speakers the option to receive either a $250
honorarium or a complimentary registration to attend the Fall Conference, although many speakers will
choose to waive compensation in this area in support of OPSC and the osteopathic profession. Please
indicate your choice on the Speaker Acceptance (page 2). If you choose to receive the honorarium, please
note that no payment will be made until receipt and approval of your signed Expense Request Form (to be
provided electronically following the Conference).
B. Travel Expenses: Upon submission of the OPSC Expense Request Form and required documentation,
OPSC will reimburse for the actual cost of travel to and from the designated location as outlined below.
OPSC staff may be available to help modify travel arrangements to ensure any additional expenses are
 Air travel may be reimbursed for up to $400. Amounts in excess of $400 must be approved
by OPSC in advance (receipts required).
 Personal vehicle mileage to and from the designated location is reimbursed at the current
IRS mileage rate at time of travel. Reimbursement shall not to exceed a round trip total of
700 miles unless otherwise specifically agreed to by the parties.
 Parking charges incurred as a necessary part of travel to the Conference can be reimbursed
for the actual amount of the expense (receipts required).
 Necessary taxi or shuttle transportation to and from the airport of origin and to and from
the destination airport and the presentation site can be reimbursed for the actual amount of
the expense (receipts required).
C. Lodging/Hotel Accommodations: The Conference Host Hotel is the Monterey Plaza Hotel, located at 400
Cannery Row, Monterey, CA 93940. Please make your own hotel reservations, if needed, prior to August
20, 2014. To make reservations, please call 800-334-3999 (reference OPSC Fall Conference for our group
OPSC will cover room and tax charges only for one (1) night, up to the OPSC Group Rate ($225/night +
tax). Any amount over that is your responsibility unless otherwise specifically agreed to by the parties.
Reservations will not be guaranteed by OPSC. Coverage of hotel expenses does not include telephone calls
or incidentals charged to the room. If you provide OPSC with your confirmation number in advance of the
Conference, we will arrange to have approved nights billed directly to OPSC (Monterey Plaza Hotel Only).
D. Meal Expenses: OPSC does not reimburse for meal expenses.
Section IV: Audio-Visual Equipment
OPSC will provide the following items for your session:
 Laptop (PC), pre-loaded with provided presentation
 Wireless Remote
 LCD Projector & Screens
 Lectern Microphone or Wireless Lavaliere
 Audience Response System*
To request additional items not on this list, please submit your request via email to Karl Baur, CMP, CGMP at
meetings@opsc.org. Additional items requested are subject to OPSC approval.
*OPSC anticipates having an Audience Response System (Turning Point 5) available for use during the Conference. This
system allows for live feedback from the audience to questions embedded in your PowerPoint presentation. A selection of
the Self-Assessment Questions you provide in advance will be inserted into your Power Point presentation by OPSC staff.
If you are interested in using the Audience Response System for additional slides, please select the appropriate box on
Page 2. We will be happy to assist you in setting up the specific slides that will be geared towards the system if you need
If slides are provided less than one (1) week prior to your talk, OPSC cannot guarantee that the Audience Response
System will be useable with your lecture. You are also welcome to set up your own Turning Point slides using their free
software, downloadable here: http://www.turningtechnologies.com/responsesystemsupport/downloads.
Section V: Cancellation
Either party may cancel this Agreement without obligation to the other if cancellation notice is received in written form at
least 30 days before appearance date.
If, due to illness, accident, causes legally known as Acts of God, or circumstances beyond the control of either party, this
contract shall be cancelled; verification may be required. OPSC shall not be liable for any payment.
OPSC will not be responsible for payment of hotel accommodations secured by the speaker but not cancelled prior to
event, in accordance with the policy of the hotel.
Section VI: General Information
A. Attire: This event is business casual. You are not expected to wear formal business attire.
B. Climate: Monterey in early September is generally dry and warm (65-72 degrees). Nights will be cooler
and can be foggy.
C. Air Service: You are asked to make your own flight arrangements.
D. Getting to and from the airport
Monterey Peninsula Airport (MRY) is located five miles from the hotel. Airlines serving the airport
include: Allegiant Air, American/American Eagle, United Express, and US Air. Taxi service is readily
available outside baggage claim and generally costs a minimum of $15.
San Jose Airport (SJC) is located 75 miles from Monterey and is served by most major airlines. The
approximate drive time is 1 hour, 25 minutes. Bus service between Monterey and the San Jose airport starts
at approximately $30 each way.
Section VII: On the Day of Your Presentation
Please check in at the Conference Registration Desk at least 30 minutes before the published start of your session for any
last-minute updates.
If you have an updated Power Point presentation to load, please allow extra time as we do not always have immediate
access to the Presentation Laptop.
10-15 minutes before the start of your presentation, please check in at the AV technician’s table in the rear of the
presentation hall. Our onsite technician will outfit you with a lapel microphone.
The Chair of the Day will introduce you at the start of your presentation. Please wait by the AV technician’s table once
your microphone is attached so that he or she will know that you are present and ready to go.
At the end of your presentation, please return to the technician’s table to turn in your microphone.
Tips for a Successful Presentation
 Bring a copy of your presentation on a USB/Flash Drive
 Arrive early
 Do not read your presentation
 Use the “Rule of 6”
o No more than six lines of text per slide
o No more than six words per line
 Use high contrast in your slides (the lights will only be slightly dimmed)
 Ensure that you cover all of the Learning Objectives for your presentation
 Include 3-5 “Take Aways” for the participants; things they can use upon returning to their practices
 Leave 5-10 minutes for Q&A at the end of your presentation
About Your Audience
 Majority of the audience (95% or more) will be DOs
 Most common Specialties are Family Practice and Internal Medicine
OPSC Fall Conference Document Checklist
Please use the checklist below to ensure on-time submission for all of your Conference documents.
Due Immediately
Signed Speaker Acceptance
Due by July 16, 2014
Bio (approximately 1/2 page in length)
Presentation Materials (i.e. Power Point file)
3-5 Learning Objectives
7-10 Multiple Choice Self-Assessment Questions (with Answers)
1-2 paragraph Lecture Description
All required documentation must be provided prior to your presentation.
If documentation is missing you will forfeit agreed upon honorarium and/or any reimbursement due to you.
Don’t Forget to make…
Hotel Reservations (by August 20, 2014)
Travel Plans (airline reservations, driving maps, etc.)
Due by October 31, 2014
Fall Conference Reimbursement Request Form
This form will be provided via email after the conclusion of the Conference.
Send all forms and presentation materials to:
Karl Baur, CMP, CGMP
Director, Meetings & Publications
Osteopathic Physicians & Surgeons of California
2015 H Street, Sacramento, CA 95811
Phone: 916-822-5246
Fax: 916-822-5247
Or Upload to:
September 12-14, 2014
Monterey Plaza Hotel
400 Cannery Row, Monterey, CA 93940