Speaker Request & Meeting Profile Form

Chapters play a pivotal role in the development of the profession by offering our members countless benefits. The following programs are designed as a benefit to ACR chapters in order to support and enhance our collective efforts.

ABOUT THIS FORM

This form allows your chapter to indicate your intent to participate in any of the following chapter programs. Staff will reach out to you in accordance with your preferences.

We require a minimum of 8 weeks notice to accommodate in-person speaker requests due to scheduling and travel of our leaders.

• Chapter Visitation Program (1 ACR speaker per chapter per year – speaker expenses covered)

• Chapter Virtual Meeting (1 virtual meeting platform per year - ACR provides the Zoom platform)

• RLI Chapter Speaker Program (RLI faculty attend meetings to present on leadership topics – speaker honoraria covered)

• Chapter CME Program (aids chapters in accrediting their meeting sessions for CME – a cost is associated with this service)

• Member of Congress Program (assists chapters in inviting a Member of Congress (MOC) or state legislator to a chapter meeting)

Items marked with an asterisk (*) are required fields.

Chapter*

Select or enter value

Name *

Please include first and last name.

Email*

Is this an annual meeting?

Yes

Meeting Start Date*

Meeting End Date*

Title of Meeting

Location of Meeting*

Include city and state of meeting location.

Venue or Virtual*

Indicate the venue of the meeting or enter virtual.

Expected Number of Attendees*

How many CME credits will be offered?

CME Provider

Registration Contact

The meeting announcement on ACR.org requires registration contact information. Please include a name, email address and telephone number for this purpose. If you would like the announcement to include a brochure or agenda please attach the file below.

Registration Contact*

Include first and last name.

Email for Registration Contact*

Telephone Number for Registration Contact

Phone

Attach brochure or agenda (optional)

Drag and drop files here or

Chapter Visitation Program - Speaker Information

If you would like to request an ACR speaker to attend your meeting please specify the meeting details below. The Chapter Visitation Program covers the ACR speaker expenses.

Chapter Visitation Program Participation*

Would your chapter like to participate in the Chapter Visitation Program and invite an ACR leader to speak at the meeting?

Yes

Date for Speaker*

Time*

Desired Length of Presentation*

Location for Presentation*

Closest Airport to Meeting*

Closest Hotel to Meeting*

Hotel Block Information

Chapter Visitation Program - Meeting Topic Information

The Chapter Visitation program draws speakers from the current Board of Chancellors or the Council Steering Committee. The speaker generally presents an update on ACR efforts and activities. You can note additional topics of interest below and the Chapter Team will make an effort to confirm a speaker who can address these.

Topic(s) of Interest

Chapter Concerns

Please indicate any current issues that the chapter is facing to further direct our selection of an appropriate speaker.

RLI Chapter Speaker Program

The RLI Chapter Speaker Program invites a RLI faculty to attend chapter meetings and present on leadership topics. The RLI Chapter Speaker program covers the RLI speaker's honoraria while the chapter assumes the RLI speaker's expenses associated with the visit.

RLI Chapter Speaker Participation*

RLI will provide honoraria directly to the speaker. The Chapter is responsible for the speaker's travel & lodging expenses). RLI staff will follow up with you regarding available speakers.

Yes

Name of RLI Speaker

If yes, please include first and last name of desired RLI speaker.

Length of RLI Session

Indicate the time alloted for the RLI speaker's presentation.

Member of Congress Program

If you would like to participate in this program ACR staff can assist you in the process of inviting a Member of Congress (MOC) or state legislator to attend your meeting.

Member of Congress Invitation Participation*

Would your chapter like to invite a Member of Congress to attend your meeting?

Yes

ACR Chapter CME Program

The ACR offers CME accreditation assistance for chapters seeking CME for their meeting session.

The ACR CME Program application and information can be found online.

CME Program Participation*

Indicate if your chapter intends to participate in the ACR Chapter CME Program.

Yes

Virtual Meeting Platform

The ACR provides an opportunity for chapters to use the ACR Zoom platform. The use of the platform does not include ACR staff assistance during the meeting; the chapter assumes responsibility for running the Zoom meeting.

Use of ACR Zoom platform

Would your chapter like to utilize the ACR Zoom platform for their virtual meeting?

Yes

Contact Information

If you have any questions, please contact the Chapter and Member Engagement team at chapters@acr.org.

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