NHMA Chapter Event Planning Form
Please note that the allotment from NHMA to each Chapter for their 2025 event(s) is $2,500. These funds do not roll over to the following year, nor does any residuals from the funding.
Contact Information
Chapter Name
*
Chapter Chair/Point of Contact Information
*
Chapter Co-Chair/Secondary Point of Contact Information
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Event Logistics
Event Name
*
Event Description (300 words max)
*
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Upload a copy of a completed or working event agenda
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Event Date
*
-
Month
-
Day
Year
Event Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Estimated number of attendees
*
Are your requesting CME accreditation for this event? If yes, please contact lmaloy@nhmamd.org for additional information and requirements.
Yes
No
Does your event feature guest speakers?
*
Yes
No
If yes, please list each speaker (including full name/credentials/title) below.
Are you requesting NHMA support to assist in identifying a potential speaker for your event?
*
Yes
No
Please upload headshot photos for all speakers.
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NHMA Programs — Please select the following topics (if any) that plan to be presented or discussed during your meeting:
*
Vaccinations
Research/Clinical Trials
HIV/AIDS
Influenza
Infectious Diseases
Mentoring
None of the above
Other
Are you requesting NHMA support to arrange a venue for this event? If no, please provide event location (please include address, parking, and security details):
*
Yes
No
Are you requesting shipping support?
*
Yes
No
Room set-up options:
Rounds
Crescent Rounds
Lecture/Classroom
Other
Set-up date (if needed):
-
Month
-
Day
Year
Date
Set-up needs to be completed by:
-
Month
-
Day
Year
Date
Breakdown date (if needed):
-
Month
-
Day
Year
Date
Are there any additional meetings planned or in progress that NHMA should be aware of? If so, list all meetings that will occur within the next 3 to 6 months.
*
No
Yes
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Catering
Are you planning to serve food and/or non-alcoholic beverages at this event?
*
Yes
No
If yes, please select what you will be providing:
Light Refreshments/Hors D'oeuvres
Plated Meal
Buffet Style
Dessert Only
Other
Are you requesting NHMA support to coordinate catering services for this event?
*
Yes
No
Are you planning to serve beer and/or wine?
*
Yes
No
Are you requesting any additional food and beverage support? Please be as specific as possible about your additional needs for food and beverage coordination and set-up.
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Marketing and Communications
Are you requesting NHMA marketing collateral and communications support?
*
Yes
No
If yes, please select all that apply:
Graphics Production
Social Media Promotions
Email Promotional Support
Print Materials Production
Other
Please upload any images, photos, etc. that you would like for NHMA to use in promotional materials (e.g. venue, group photos, etc.):
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Are you requesting NHMA's assistance with procuring audio/visual service assistance?
*
Yes
No
If so, please use the space below to be as specific as possible regarding your needs. Audio/visual service requests may include video cameras, microphones, lighting support, virtual meeting platforms, etc.
Will you be recording audio or video at your event?
*
Yes
No
If so, are you requesting to publish this audio, video, or photos on the NHMA website and/or NHMA social media channels?
Yes
No
Does your event require virtual meeting support?
*
Yes
No
Please use the space below to provide additional information about your chapter event/meeting that is not covered in the form.
*
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