Faculty Application for The Physician Wellness and Financial Literacy Conference (WCICON20)
Please fill out each question as best you can. Most of them are required. The more you leave blank, the less likely you are to be selected as a speaker. There has been a great deal of interest in speaking at the conference, so choosing speakers will unfortunately be a competitive process. The following factors will all have significant impact on whether you are selected as a speaker or not: Requests from potential attendees for you and your topics, the number of talks you are willing to give/panels you are willing to moderate, whether your talk(s)/panel qualifies for CME, prior experience, your topic(s), and the costs of bringing you to speak.
What is your name? *
Your answer
What is your email address? *
Your answer
What is your phone number? *
Your answer
Why should you be selected as a speaker? (Include a paragraph +/- links to prior speaking engagements/videos) *
Your answer
Are you willing to provide a copy of your slides to attendees? (Note: A "no" answer will likely result in you not being invited to be part of the faculty) *
The conference will be packaged up into an online course afterward including your video images, audio, and slides for which there will be no additional compensation beyond the speaker fee. Will this be acceptable to you? (Note: A "no" answer will likely result in you not being invited to be part of the faculty) *
What do you expect to be paid to be part of the faculty? *
What is the minimum you would be part of the faculty for? (i.e. I should not bother calling you if you won't be paid at least this much) *
I understand that faculty compensation payments will vary by presentation type (keynote, break out session, panel moderator, panel member) and number, and thus some faculty members will be paid more than others. *
The remaining 12 questions will be primarily used to determine whether your presentation(s)/panels qualify for CME credit. Fill them out very carefully. At a minimum, the first 3 must be completed. What is the title of your FIRST presentation/panel discussion? *
Your answer
Please describe the content of your FIRST presentation/panel discussion in one paragraph *
Your answer
List five objectives of your FIRST presentation/panel discussion *
Your answer
If a panel discussion, suggest possible panel members
Your answer
What is the title of your SECOND talk/panel discussion?
Your answer
Please describe the content of your SECOND presentation/panel discussion in one paragraph
Your answer
List five objectives of your SECOND presentation/panel discussion
Your answer
If a panel discussion, suggest possible panel members
Your answer
What is the title of your THIRD talk/panel discussion?
Your answer
Please describe the content of your THIRD presentation/panel discussion in one paragraph
Your answer
List five objectives of your THIRD presentation/panel discussion
Your answer
If a panel discussion, suggest possible panel members
Your answer
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