Speaker Registration Form

Speaker Registration Form

Want to register to be a speaker and share your health services expertise? Fill out our form to participate! Form Preview
  • Speaker Agreement


  • Upload of Required Documents

    This form cannot be submitted without these files.
  • Click here to complete your W9 form AND

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  • Hotel Accommodations

    The Sheraton Harrisburg/Hershey, Harrisburg, PA
  • Speaker Agreement

    The Pennsylvania Medical Society (PAMED) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to award Category 1 credit for physician education. The Medical Society expects faculty participating in the Category 1 activities which are either directly or jointly-sponsored activities to adhere to the following guidelines:

    ACCME Standards for Commercial Support

    As an accredited CME sponsor, PAMED requires that all speakers comply with the ACCME Standards for Commercial Support of CME. The ACCME’s Standards for Commercial Support require that anyone in the position to control the content of a Category 1 activity disclose all relevant financial relationships with commercial interests within the past 12 months in order to assess if there is any potential conflict of interest. As a faculty member, you are required to disclose any financial interest or relationship that you may have with any commercial company or the manufacturer(s) of any commercial product/service. PAMED has a standard disclosure form which you will be asked to complete and return to our office. Any individual that refuses to disclose relevant financial relationships cannot be included in the Category 1 CME activity. If PAMED determines that a potential conflict of interest exists, we are required to resolve that conflict prior to the activity. A variety of methods may be utilized to accomplish resolution of a conflict of interest, such as an independent content review. If you are identified as having a potential conflict of interest, we will contact you to discuss the course of action which will be taken.

    The Commercial Support Standards also require that your presentation be free of commercial bias and that any information regarding commercial products/services be based on scientific methods generally accepted by the medical community. When discussing therapeutic options, it is our preference that you use only generic names. If it is necessary to use a trade name, then those of several companies must be used. Please do not include names of commercial interests in your presentation. A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Further, should your presentation include discussion of any unlabeled or investigational use of a commercial product, we ask that you disclose this to the participants. Should you determine that you cannot comply with these requirements or any of the provisions of the Commercial Support Standards, please call PAMED’s Office of CME at (800) 228-7823 as soon as possible.

    CME Presentation Guidelines

    Activities accredited for CME by the Pennsylvania Medical Society may not promote recommendations, treatment, or manners of practicing medicine that are not within the definition of CME and are known to have risks or dangers that outweigh the benefits or are known to be ineffective in the treatment of patients and as such must follow the ACCME guidelines listed below:

    · The content or format of a CME activity or its related materials must promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. (SCS 5.1)

    · Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the CME educational material or content includes trade names, where available trade names from several companies should be used, not just trade names from a single company. (SCS 5.2)

    · All the recommendations involving clinical medicine in a CME activity must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients. (CME Clinical Content Validation)

    · All scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental de-sign, data collection and analysis. (CME Clinical Content Validation)

    · Educational materials that are part of a CME activity, such as slides, abstracts and handouts, cannot contain any advertising, corporate logo, trade name or a product-group message of an ACCME-defined commercial interest. (SCS 4.3)

  • AGREEMENT REGARDING THE USE BY THE PENNSYLVANIA RHEUMTOLOGY SOCIETY OF PROFESSIONAL MEDICAL EDUCATIONAL MATERIALS

    The Pennsylvania Rheumatology (“PRS”) wishes to place on its website, http://www.parheumatology.org/.org, (“thewebsite”) professional medical educational material:

    ("the Presentation(s)”) of which Dr. (name as signed in the box below and now referred to as “I”) is the author or an author. The Presentation will be made available to PRS members in satisfaction of their CME requirements and/or for general educational professional purposes. PRS is taking that action for primarily educational purposes and, in particular, to promote broader understanding of the subject matter of the Presentation. The Presentation will remain on the website for as long as three years, but PRS may remove the Presentation from the website at any earlier time in its sole discretion.

    I understand that I will receive no compensation from PRS for any use of the Presentation or an Altered Presentation (as defined in the following paragraph). I agree that allowing PRS to post the Presentation or Altered Presentation provides professional benefits to me. For good and valuable consideration and intending to be legally bound, I enter into this Agreement.

    By completing the box below, I hereby authorize the usage of my Presentations and agree that PRS’s usage shall not be a violation of my ownership interests, including any copyright I hold, in the Presentation. I further grant permission for PRS and any person or entity authorized by it: (i) to edit or alter the Presentation (any such edited or altered Presentation is referred to in this Agreement as an “Altered Presentation”), so long as doing so does not adversely or substantially affect the professional content; (ii) to distribute, broadcast, publish and/or transmit all or any portion of the Presentation or an Altered Presentation on its website for the purposes described above; and (iii) to use my name, likeness and biographical material in connection with any of the foregoing, all to the extent and in such fashion as they deem necessary or desirable to accomplish the purposes described in the first paragraph of this Agreement.

    I represent that I am the owner of the copyright (solely or jointly) and have the right to permit use of the work by PRS. I further represent that to the extent that the Presentation uses any third- party material in a manner that requires agreement from such third-party holder to that use, that I have obtained such agreement.

    I hereby release PRS, its individual members, and those members' home institutions from any claims or liability regarding any use that may be made of the Presentation or an Altered Presentation that is authorized by this Agreement.

    If you authorize PRS to place your lecture presentations on the PRS website, please type "Yes" in the box below. If you do not authorize PRS to place your lecture presentations on the PRS website, please type "No" in the box below. Thank you.

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