NETWORK draft

*NETWORK LEADERS - USE THIS FORM * Network EVENT & CE application
Upon submitting your event information, it will be added to the AVA calendar. If you would like to offer CE credit you must fill out the CE application portion of this form. Please submit this form at least 10 business days before you plan to advertise your event to give us time to review your application.
You are required to review the 2024 CE program approval policy prior to completing this form.

https://cdn.ymaws.com/www.avainfo.org/resource/resmgr/files/networks/leader_resources/ce_approval_policy5_2024.pdf
Event Submission Section

The information in this section will be used for updating the event calendar
Network Name*
Network Acronym*
Event Date*

MonthDayYear
Date
Event Start Time*

:HourMinutesAM/PM Option
Network Event Contact*

First NameLast Name
Network Email*
example@example.com
Event Contact Phone Number (Optional: Will be listed on the calendar entry)

Area CodePhone Number
Event Title*
Example: Network Event or spring symposia
Sponsor (if any)
Event Location*
Event Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Event Flyer with Registration Info*

Browse Files
Must be PDF, Word, or Text file format (no screenshots). Cancelof
Registration link (if not on flyer)
Graphic for Social Media

Browse Files

Cancelof
YesNo

AVA USE ONLY

FOR APPROVAL FOLLOW UP PROCESS
AVA Use ONLY: Approval Status
Requires revision of DISCLOSURE slide(s)Requires revision of OBJECTIVES slide(s)Concern for IMPLICIT BIAS during presentation
AVA Use ONLY: Comments to CE applicant

AVA CE Application
You must submit this application at least 10 business days prior to advertising your event for approval. A copy of the CE Approval Policy can be found on the Network Officer Resource page at: https://avainfo.org/networkofficers. Please note that this application is only required if you are wanting to offer CEs using AVA's Provider Number.
Speakers who are using a presentation that has been previously approved by AVA will be given an approval code. You can request this code from your speaker or locate it on the Network Officer Resource page at https://avainfo.org/networkofficers.
*If you have more than one presentation for an event, you will be required to fill out a separate application for each.
NOTE: Upon application approval, you will receive a link to the CE evaluation survey to give to your attendees. Your attendees will receive an email CE certificate after submitting the evaluation.

AVA gives your attendees 30 days to fill out the evaluation to obtain CE credit. Event/Speaker Evaluation feedback will be emailed to the network after this 30 day period and the evaluation survey link will be closed.
YesNo

Speaker WITH pre-approval code
Speakers who are using a presentation that has been previously approved by AVA will be given an approval code. You can request this code from your speaker or locate it on the Network Officer Resource page at https://avainfo.org/networkofficers
Speaker*

First NameLast Name
Speaker 1 Presentation Title*
Speaker 1 Pre-Approval Code*
YesNo

Speaker 2*

First NameLast Name
Speaker 2 Resume/CV*

Browse Files
Must be in PDF, Word (doc or docx), or Text (txt) format. Cancelof

Speaker 3*

First NameLast Name
Speaker 3 Resume/CV*

Browse Files
Must be in PDF, Word (doc or docx), or Text (txt) format. Cancelof

Thank you for filling out the Network Event/CE Application.

If you are applying for CE approval, you will receive notice within 10 business days. Non-CE events will be added to your network calendar within 1-2 business days.
If you noted that you have additional speakers, you will be redirected to repeat this form on the next page.
Should be Empty:

NETWORK LEADERS - USE THIS FORM Network EVENT & CE application