IASLT CPD Event Agreement Form

Please provide the following information relating to the proposed CPD event. The event will be confirmed following approval from the IASLT CPD Committee or CPD Team. IASLT requests all information below at least 8-10 weeks prior to the proposed event date.

1. NAME OF PROPOSED EVENT *

2. DATE AND TIME *

3. LOCATION *

4. MAIN CONTACT AND CONTACT INFORMATION:*

5. Main Contact Email Address *

example@example.com

6. Total speaker/ facilitator fee requested for this event.*

Total amount of costs involved MUST be confirmed prior to opening registration. IASLT will not be held liable for any additional costs that occur post-event. In some cases, speakers generously donate their time, or request that a donation be made in lieu of payment. Please indicate your preference here if this is the case.

7. Course overview*

8. Learning Objectives*

9. Speaker(s) Bio - Please provide a brief bio (and headshot optional can be uploaded below). This information will be used in promotion of event.*

10. Headshot - if applicable. This will be used in promotion of event.

11. Maximum capacity*

13. Do you consent to IASLT recording this CPD event and making this recording available to members and other HSCPs (where relevant) via the IASLT website for a fee?*

YesNoYes, but only available to those who have attended.Yes, but only for a certain specified time.

14. Do you consent to IASLT making audio and/ or visual recordings of the CPD event to promote the event via social media?*

YesNo

15. Any pre-event course materials/resources must be emailed to kathleencpdadmin@IASLT.ie 7 days in advance of the event, and post-event materials for distribution to participants should be provided no later than 7 days post-event.*

AgreeDisagreeN/A

16. Please indicate any specific participant criteria that applies to this event.

17. Please indicate any other information specific to this event that you feel should be taken into account in the planning stages of this event.

18. By ticking the box, I confirm that I agree with the following statements.*

IASLT manages all aspects of the CPD event including planning, promotion and management. All responsibilities, governance and ownership of the event fall with IASLT. While IASLT welcomes suggestions on event themes/ facilitators/ topics from a wide variety of groups and individuals, all Category 1 IASLT CPD Events are governed by IASLT with responsibility falling under the remit of the IASLT Professional Development Manager. All funding applications to the National HSCP Office submitted by IASLT fall under this category.

19. Please sign here to indicate your consent and agreement with the above information.*

(For office use only)Does this align with IASLT Strategy/IASLT member priorities/ HSCP Priorities/principles of inclusion and diversity? Provide rationale.