Speaker Biographical and Conflict of Interest Form Fall 2015

Speaker Biographical & Conflict of Interest Form Fall 2015

One Health Arkansas 2015 Lung Cancer Symposium 2015

Step 1 of 3

  • Please list your administrative assistant's name and contact information (if applicable)

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  • Please upload your most current CV/resume
  • This picture may be displayed on the conference website and/or used in any media concerning this conference and your involvement.
    *Off-label use is the practice of prescribing pharmaceuticals or devices for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration.
  • UAMS is encouraging course directors to incorporate planning by the health care team for the health care team to produce interprofessional education. We have identified the following targeted learners for this activity: healthcare professionals working with patients with lung cancer or tobacco-related disease, including physicians, nurses, pharmacists, social workers, counselors, and other allied health care professionals. Also included in our target audience: advocates and public policy professionals involved in tobacco cessation work, and patients and caregivers who have been impacted by tobacco and/or tobacco-related disease. If there are any other potential learners for whom you feel your presentation would be relevant, please list them above.
  • Nursing accreditation requires that you provide scholarly references. Professional association websites, or generally applicable articles are fine. List DOES NOT have to be all-inclusive of everything consulted for your talk. If you include references in your presentation slides, you may skip this field.
  • If you prefer, you may upload a file with your references. If you have listed references above, or if you plan to include them in your slides, you may disregard this.
  • Drop files here or
    Please upload your powerpoint presentation here as well as any additional course materials you may have. IF YOUR FILE IS OVER 20 MB please email it to

  • Please list a minimum of 3 objectives per credit hour of presentation.

    Remember learning objectives must be consistent with the above activity type and must be measurable. If your target audience includes both pharmacists and technicians, you must write separate objectives for both audiences that apply to their scope of practice.

    (*Verbs to AVOID while writing objectives: appreciate, enjoy, really understand, be acquainted with, fully appreciate, realize, be aware of, grasp the significance of, remember, be familiar with, sympathize with, believe, know, understand, comprehend, learn)

  • Please list learning objectives for your presentation.
  • Give a general overview of the content (i.e. key points) your presentation will address. These should be more extensive than your objectives, and can be simply a list of content points to be covered rather than complete statements.
  • Evaluation questions are necessary in order to comply with CE accreditation policy.
  • This should include experience that is relevant to THIS talk.
  • Please describe any audio visual requirements you will have for your presentation.