Call for Presentations 2019 Rocking Chair Conference 1 Speaker Information2 Presentation Information3 Travel and Honorarium We welcome multiple presentation proposals but please complete one (1) form for each proposal.AARC membership numberName First Last Credentials RRT CRT NPS ACCS SDS RPFT CPFT RPSGT MD DO RN Other CredentialsThis field is for special or educational credentials you would like on your name badge.Company / OrganizationAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Business PhoneCell Phone Presentation TitlePlease provide two or three overall objective for your presentation.Required for purposes of the CRCE application.Speaker Brief Introductory Information or BioUsed for podium introduction.Which day do you prefer to present?*The education committee has final control over lecture schedules.ThursdayFridayNo preferenceAny conflict of interest to disclose?*Required for purposes of the CRCE application.NoYesIdentify your conflict(s) of interest.*Please include all conflict(s) of interest and include the statement on your presentation.Is the presentation being sponsored by an organization?*NoYesName sponsor*Please indicate any special needs for audiovisual equipment at the conference*Note: Laptop PC is standard with LCD projector, MAC users please provide projector adaptors.NoneYesOther A/V needs* Speaker ExpensesWill your employer cover all your conference expenses?*NoYesPlease contact Joseph McDonald to discuss.Will you need any reimbursement not covered by your sponsor / employer?*NoYesPlease explain:Do you have any transportation needs to and from the conference?*NoYesPlease explain:Any additional requestsProgram Integrity and Honorarium Statement*Program Integrity To ensure that all educational activities are free from bias, all presenters must declare vested interests. In the event that any form of commercial support is provided for an educational activity, the course sponsor will maintain control of the educational content and disclose to the learners all financial relationships or lack of, between the commercial supporter and the provider or presenters. Funds from a commercial source will be in the form of an unrestricted educational grant to the provider of the educational activity and must be acknowledged in printed material and brochures. Learners must be made aware of the nature of commercial support of all educational sessions. Educational activities that present research conducted by commercial companies will be designed and presented with scientific objectivity. Learners will be informed of any off-label use of a commercial product that is presented in educational activities. Off-label use refers to using a pharmaceutical agent for a purpose other than the purpose for which it was approved by the FDA. The approval status for an educational activity granted by the AARC does not expressly or implicitly confer AARC endorsement of the activity’s content. Honorarium Honorarium Application and requests do not imply guaranteed reimbursement of any requested fees. The committee reserves the right to provide full, partial or no reimbursement requests. I agree to the Program Integrity and Honorarium statement. Presentation proposals close on February 22, 2019. Speakers will be notified of selection by March 20, 2019.CommentsThis field is for validation purposes and should be left unchanged.