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Presenter Agreement Form - Houston 2016

Texas Osteopathic Medical Association


Presenter Agreement Form

Thank for you for agreeing to present a lecture at the Houston Educational Regional Seminar which will be held September 24, 2016 at the Omni Houston Hotel, 4 Riverway, Houston, TX 77056.

HOTEL ARRANGEMENTS: You will receive (1) night hotel lodging of a standard room at the meeting group rate.  Any additional nights and food and room incidentals are the responsibility of the presenter.  Presenters are responsible for making their own reservations. The group rate is $135 + tax.  Please use this link to access the online reservation page. You may also call reservations at 713-871-8181.

Audio-Visual Equipment
Each session will have the following equipment: laptop, screen, projector, podium/mic. If your session requires additional audio visual equipment you must submit your request by email to no later than September 6th.  Requests will be reviewed on a case by case basis.  If you are a MAC user, we ask that you bring your personal MAC laptop with needed accessories.


TOMA is accredited by the American Osteopathic Association as a category 1A CME provider. For program accreditation and promotional purposes, we require the following: (NOTE: 1,2,3,5 were submitted with your proposal).


1. Presentation Title

2. Brief Abstract/Session Description

3. Learning Objectives   COMPLETED
4. Pre and Post Test Questions*   place in presentation
5. CV and/or Bio  COMPLETED
6. Power Point Presentation – must be submitted electronically                  


7. Signed Disclosure Statement

8. Needs Assessment**  UPLOAD HERE

*PRE & POST TEST QUESTIONS measure the knowledge gained from the presentation. An Audience Response System will be used by participants during the presentation. Please choose 3-5 questions to begin and end with. Test questions should be slides within your Power Point Presentation.


**AOA NEEDS ASSESSMENT is the systematic process of gathering information and using it to determine instructional solutions to close the gap between what the physician does know and what the physician should know to be competent or an expert in his or her field.  Your needs assessment should identify and measure the areas for improvement in your target audience and determine methods to achieve improvement.


All presentations must be evidence-based and completely free of commercial bias (no logos, brand products etc...).


For handout purposes, all presentations, unless otherwise specified, will be posted to the seminar website, accessible as a “read only file” to registered attendees. They will be deleted 90 day’s post-conference. There will not be paper handouts provided to attendees; if you wish to provide them you must prepare them and bring them to your session.


Thank you again for being part of our Seminar. We value you and appreciate your contribution to our continuing education event.  If there are any questions or if you experience trouble uploading the required documents, please do not hesitate to contact Lisa Gallo, CMP - or 800.444.8662.


If these arrangements are agreeable to you, please enter your name below and press submit to sign the Seminar Presenter Agreement.


All presenter forms/requirements are due by September 6th.

PowerPoint presentations are due by September 16th. 

Watch your email for reminders!




Texas Osteopathic Medical Association
1415 Lavaca Street | Austin, Texas 78701
512.708.8662 | (t) 800.444.8662 | (f) 512.708.1415
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