CANA 2023 Spring Meeting – Speaker CE Form

Thank you very much for sharing your time and expertise with CANA Member-Owners as a speaker at the upcoming CANA 2024 Annual Fall Meeting. Please complete the form below to provide the information that CANA needs to obtain CE credit approval for your presentation. If you are presenting more than one session, please submit a separate form for each presentation.

Presentation Topic Details

Title of Session (will be used in meeting materials moving forward)*

Short Description/Outline of Lecture*

Learning Objective(s) - At the conclusion of this presentation, the participant should be able to...*

State each measurable learner objective in terms of what the participant will be able to do after attendance of this session. One (1) objective is required for each lecture hour (if speaking for only a 1/2 hour, please include one (1) learning objective). Need help with your learner objectives? View these helpful guidelines from the AANA: https://www.aana.com/docs/default-source/continuing-ed-aana-com-web-documents-(all)/writing-learner-objectives-web-doc.pdf?sfvrsn=9e5e49b1_6

Speaker Details

If you have more than one speaker, one speaker should complete this form only. Other speakers should complete the form found here (copy and paste the link that follows): https://canainc.org/cana-2024-annual-fall-meeting-speaker-details-only/

Name, Title, Credential of Presenter (ex. Jane Doe, CRNA, MBA)*

Email*

Phone*

Mailing Address*

Street Address City State ZIP Code

Include the address to which your honorarium should be sent.

Short Bio (150 words or less)*

Please type your bio in paragraph form (no bullets) and keep it brief. This bio will be used for introductions, prior to your session.

Photo (Headshot preferred)

If it is easier for you to email the photo separately, please send to info@canainc.org

Max. file size: 1 GB.

Speaker Agreement

As a speaker you agree to the following:

Services to be Performed

You agree to speak during the session(s) as outlined;
You understand and agree to comply and meet the deadlines set forth;
You agree to monetary compensation for your participation in the CANA 2024 Annual Fall Meeting, as outlined in your speaker confirmation (this may mean no monetary compensation);
You grant a non-exclusive license to use the Material(s) you provide, your name, likeness and biography for the delivery and publicity of this Program (this includes, but is not limited to hardcopy print, electronic distribution, and web posting on the CANA website)*;
You grant an exclusive license to use the recordings from your session during the meeting for the delivery of online CE courses, at the discretion of CANA. If you communicate that you do not wish for your presentation materials to be shared, CANA may make accommodations otherwise.
You warrant that you have authority to grant these rights, that you have full power and authority to do so, and that the Material(s):
1. Is/are original with You;
2. Is/are not subject to any third party copyright;
3. Is/are factually accurate
4. That publication will not libel anyone or infringe on or invade the rights of others; and
5. That you have obtained permission from the copyright proprietor consistent with this use for any third party copyrighted material used in the Material(s)
You agree to help find a replacement speaker, should you find that you can no longer participate in the session(s) at which you previously agreed to speak.

Agreement*

I hereby agree to the terms listed above as they relate to my speaking engagement at the CANA 2024 Annual Fall Meeting.

Donate Your Honorarium*

Speakers may choose to donate their honorarium listed in the speaker agreement back to CANA. Your donation will allow CANA to continue to provide valuable education and policy support to our CANA Member-Owners.

Donate my honorarium to future CANA educational endeavors.
Send my honorarium to the address listed on this form.

Lodging

One (1) standard hotel room for one (1) night at the lowest conference rate (plus taxes and fees) at the host hotel, the Hyatt Regency Newport Beach, will be pre-paid by CANA. Any additional nights of stay will be the responsibility of the speaker. Note – a room night will only be covered if the meeting location is more than 100 miles from the speaker’s residence or at least two hours travel time is required. Because rooms are limited at the discounted CANA rate, staff has pre-booked your room for the following nights: Check-in: Friday, October 25 @ 4:00 PM Check-out: Sunday, October 27 @ 12:00 PM

Are your nights of stay correct, as listed in the above description?*

Yes
No (if you select "No", enter your dates of stay below)

Check-in Date*

Check-out Date*

Preferred Bed Type

Single King
Double Queen

Additional Room Requirements

If you have any additional room requirements (i.e. mini fridge, pack 'n play, down alternative comforter, etc.), please enter them here. CANA will make the request with the hotel, but please keep in mind it is up to the hotel to fulfill the request. Please check with the hotel, upon check-in or call ahead. ALL fees associated with additional requests are at the expense of the speaker.

CANA Speaker CE Form

Presentation Topic Details

Speaker Details

Speaker Agreement

Lodging

Contact Information

Information

Policies

CANA Speaker CE Form

Presentation Topic Details

Speaker Details

Speaker Agreement

Lodging

Contact Information

Information

Policies

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