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IASA Chapter Speaker Agreement
Please complete the acknowledgement form below regarding speaker responsibilities and request for possible streaming and recording of presentation for IASA on-demand educational offerings. Please provide data in all REQUIRED fields to expedite processing of your session and speaker details. Required fields left blank will generate a follow up communication to collect required data.
Speaker Name
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First
Last
Speaker Title
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Company
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Company location (city, state)
Speaker email
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Speaker Cell Phone (in case of issues during event)
*
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Chapter Presenting At
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Please select
Carolinas
Central Illinois
Chicagoland
Georgia
Indiana
Land O'Lakes
Metro NY/NJ
Michigan
Mid-Atlantic
Mid South
Midwest
Northeastern
Ohio
Pacific Northwest
Show Me
Southwestern Ohio
Sunshine
Texas
Utah
Wisconsin
Chapter Event Month
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Please select
January
February
March
April
May
June
July
August
September
October
November
December
Chapter Event Year
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Speaker Bio - Please provide your professional bio required for CPE (Note for Ethics field of study sessions your bio must include and clearly show your relevant experience or training in this field):
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Speaker photo (please submit high res photo) Photos can be most any size. 8:5:11 - generally size of a document, for 1:1, common size would be 1080 x 1080 pixels.
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Presentation Title - Required for CPE
(80 Character limit)
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Program Level Required - Defined as Basic, Intermediate or Advanced (Intermediate and Advanced require pre-requisites - If selecting these options you must list prerequisites and advanced preparation fields.
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Prerequisites - If Program Level above is listed as Intermediate or Advanced, you must list any prerequisites such as education or work experience or knowledge to qualify content for CPE credit.
Advanced Preparation - If Program Level above is listed as Intermediate or Advanced, you must list any prerequisites such as required pre-meeting work that will be provided (or None) to qualify content for CPE credit.
Field of Study Required - Please select one from the drop down box
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Please select
Accounting
Accounting (Governmental)
Auditing
Business Law
Economics
Finance
Information Technology
Management Services
Regulatory Ethics
Specialized Knowledge
Statistics
Taxes
Behavioral Ethics
Business Management & Organization
Communications and Marketing
Computer Software & Applications
Personal Development
Personnel/Human Resources
Production
Please select all that apply. Note for Accounting, Auditing or Taxes one or more of the content reviewers or developers must meet one of the below requirements.
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I am a licensed CPA in good standing
Please select
Yes
No
I am a Tax Attorney
Please select
Yes
No
I am an IRS Enrolled Agent
Please select
Yes
No
One of the developers or reviewers of this of content is a licensed CPA,, Tax Attorney or Enrolled Agent
Please select
Yes
No
None of the above
Please select
Yes
No
License Number if applicable (Required for Accounting, Auditing or Taxes Field of study by at least one presenter or content developer.
Session Description - Required for CPE, Provide 2-3 sentences describing what the attendee will gain from this session
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Learning Objectives - Minimum 3 Required for every 50 minutes of content and Learning Objectives - THREE (3) Required for every 50 minutes of content. ONLY THE FOLLOWING MEASURABLE VERBS MAY BE USED AS REQUIRED BY NASBA TO QUALIFY FOR CPE CREDIT:
OBJECTIVES MUST BEGIN WITH DEFINE, DETERMINE, DIFFERENTIATE, DISCRIMINATE, DISTINGUISH, IDENTIFY, INDICATE, INTERPRET, RECALL, RECOGNIZE.
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Would you be interested in presenting at other chapter events?
Yes, with travel expenses paid
Yes, with speaker fee and travel expenses paid
Would need more information to decide
No, I am unable to travel to other chapters
I. PARTICIPANT AGREEMENT: OBSERVANCE OF IASA CHAPTER POLICIES
Please check each box below to acknowledge that you have read and understand each section, and will satisfy all of your obligations and responsibilities as an IASA speaker.
The content of CPE activities does not promote the proprietary interests of any commercial interests.
Content of CPE activities will be restricted to industry issues and operation of devices and should not include product or company names unless essential.
Generic/Trade Names: Presentations must give a balanced view of options. Use of generic names will contribute to this impartiality. If trade names are used, those of several companies should be used rather than only that of a single manufacturer.
Speaker shall own the copyright in all materials provided for, or created by Speaker at the Event except for materials specifically created solely for IASA’s use or materials incorporating IASA’s intellectual property.
Speaker grants IASA a nonexclusive, worldwide, royalty free license to use, reproduce, and distribute the intellectual property in connection with this Event, if they choose to provide their intellectual property.
Speaker grants IASA and its agents and employees a royalty-free, perpetual license to publish, reproduce or otherwise use the Speaker’s name, picture, likeness, comments, or voice for any lawful purpose in all media in connection with the Event.
IASA warrants that usage as described herein shall be solely related to the Event and shall remain appropriate for the insurance industry and shall not in any way be considered derogatory or damaging to the Speaker or Speaker's Company.
Speaker is knowingly and voluntarily taking part in the activities for which their image is being captured and understands the associated requirements.
Speaker releases and waives any and all claims, damages, losses and expenses as a result of, or arising from, their participation.
To the best of Speaker’s knowledge, their presentation does not violate any proprietary or personal rights of others (including any copyright, trademark, or privacy rights), is factual and contains nothing defamatory, unlawful or inappropriate.
Speaker has obtained all necessary licenses and permissions for any third party intellectual property including, but not limited to, music, video or other media shown as part of the Speaker’s presentation.
Speaker shall conduct themselves in a professional and civil manner and in accordance with the IASA's Code of Ethics.
Speaker agrees that no portion of the resulting media created at the Event, containing Speaker’s name, biographical information, quotes, photographs, or recorded interviews needs to be submitted for any approval.
II. PERMISSION TO RECORD AND/OR LIVE STREAM:
In continuation of the IASA initiative to increase the value of our educational offerings to registrants, the above referenced presentation may be made accessible to the insurance community after the event and may be offered for a fee at the discretion of the IASA. The presentations may be used for continuing education courses for IASA. Please check one:*
1. I give permission for my presentation to be recorded and/or live streamed and made available to the insurance accounting community via the IASA eLearning Center for future viewing and possible sale.
1a. Edits to the original video will be limited only to removal of audio/video not related to the speaker's direct presentation, i.e. front and back end video/audio trimming.
2. I give permission for my presentation to be presented live but NOT recorded and made available as described above.
3. I do not give permission for my presentation to be recorded and made available as described above.
4. I give permission for my presentation to be used, in whole or in part, through other IASA distribution channels for post event educational content promotions.
III. SOCIAL MEDIA SITES:
Help IASA promote your session! Please include the following social sites for you and your company so that IASA can tag you in session promotions.
Company Facebook page (www.Facebook.com/ABCCompany)
Company LinkedIn page (www.linkedin.com/company/ABCCompany)
Company Twitter handle (@ABCCompany)
Personal Twitter handle (@yourhandle)
Web Site