ISSWSH Webinar Proposal Form

1

Submitter Name and Surname * This field is required.

(please include credentials)

2

Submitter Name* This field is required.

First Name

Last Name

Credentials

3

Submitter Email Address* This field is required.

example@example.com

4

What is the topic of your proposed webinar?* This field is required.

5

What is the suggested title of your proposed webinar?* This field is required.(this is exactly how it will be promoted)

6

What type of event is this talk to be set up as?* This field is required.Events that need to be setup in Zoom as an interactive event with participants will be set up as a meeting. An event that is to be set as a lecture, with Q&A at the end will be set up as a webinar.

Zoom Meeting

Zoom Webinar

7

Who is the suggested moderator?* This field is required.Credentials - i.e. MD, PhD, DO, etc.

First Name

Last Name

Credentials

8

Moderator Email* This field is required.

example@example.com

9

Who would you like to invite to speak?* This field is required.Credentials - i.e. MD, PhD, DO, etc.

First Name

Last Name

Credentials

10

Panelist #1 Email* This field is required.

example@example.com

11

Who else would you like to invite to speak?* This field is required.Credentials - i.e. MD, PhD, DO, etc.

First Name

Last Name

Credentials

12

Panelist #2 Email* This field is required.

example@example.com

13

Are there more than 2 panelists who you wish to invite to speak?* This field is required.

Yes

No

14

Who else would you like to invite to speak?* This field is required.Credentials - i.e. MD, PhD, DO, etc.

First Name

Last Name

Credentials

15

Email* This field is required.

example@example.com

16

Who else would you like to invite to speak?Credentials - i.e. MD, PhD, DO, etc.

First Name

Last Name

Credentials

17

Email

example@example.com

18

Who is/are the proposed webinar moderator(s)? *Please note the the submitter will be considered a moderator unless two moderators are identified below.* This field is required.

Please include email address(es)

19

Who is/are the proposed webinar speaker(s)?* This field is required.

Please include email address(es)

20

Please note that if a topic is approved, a tentative date will be proposed and the ISSWSH office will send out invitations to the identified moderators and speakers. If any speaker or moderator declines the invitation, it is the responsibility of the submitter to identify any proposed replacements or changes to the program. Generally speaking, ISSWSH webinars are one (1) hour in length. This roughly includes an introduction by the moderator(s), the lecture(s), and Q&A at the end if time allows. How much time do you feel your webinar will require?* This field is required.

21

Please note that if a topic is approved, a tentative date will be proposed and the ISSWSH office will send out invitations to the identified moderators and speakers. If any speaker or moderator declines the invitation, it is the responsibility of the submitter to identify any proposed replacements or changes to the program. Generally speaking, ISSWSH webinars are one (1) hour in length. This roughly includes an introduction by the moderator(s), the lecture(s), and Q&A at the end if time allows. How much time do you feel your webinar will require?* This field is required.

One (1) Hour

Ninety (90) Minutes

Two (2) Hours

Other

22

Typically, webinars are held on the 3rd Tuesday of a given month and begin at 7:00 p.m. CST. This in mind, what is the date desired for this webinar?* This field is required.

Date

23

Description of this webinar event. * This field is required.Please share exactly what you would like posted online to describe what this webinar will be about. Be impactful with your words to entice people to attend - something that will GRAB their attention (we suggest using ChatGPT or any other AI to aid in coming up with a short synopsis of your event).

24

Other