• 2024 ACP Poster Session Presenter Paperwork

    2024 American College of Prosthodontists Poster Session Presenter Paperwork
  • Contact Information

  • Presentation Information

  • Please Provide Your Presentation Synopsis.

    If you have revisions after submitting, please email them to Emily Deadman at edeadman@prosthodontics.org. 

  • Please List Three Presentation Objectives – 10 words or less per objective.

    At the conclusion of this session, attendees should be able to:
    (e.g. Describe techniques commonly used to assess vertical dimension.)

    Appropriate Verbs for Learning Objectives 

  • Biographical Sketch and Headshot

    Please provide a current biographical sketch of 75 words or less. If your sketch is longer than 75 words, it will be edited to fit the space. Please write it in paragraph format.
  • If you would like, please provide us with a recent color photograph (headshot). Resolution must be at least 300 dpi in .jpg, .gif, or .tif format.

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  • Disclosure of Relevant Financial Relationships and Conflicts of Interest (COI)

    Please electronically sign and date the ONE statement appropriate to your presentation.
  • Relevant Financial Relationships
    For a person involved in the planning, administering or presentation of a continuing dental education activity, ADA CERP considers relevant financial relationships to be financial relationships in any amount, occurring in the last 12 months, that are relevant to the content of the CDE activity and that may create a conflict of interest. ADA CERP considers relevant financial relationships of the person involved in the CDE activity to include financial relationships of a family member. Relevant financial relationships must be disclosed to participants in CDE activities in writing.

    Conflicts of Interest (COI)
    ADA CERP considers that a conflict of interest may exist when an individual has an opportunity to affect the content of continuing dental education activities regarding products or services of a commercial interest with which he/she has a financial relationship.

  • For No Financial Interests:

    I, the undersigned, declare that neither I nor any member of my family have a financial interest/arrangement or affiliation with any corporate organization offering financial support or grant monies for this continuing dental education program. 

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  • To Declare Existing Commercial / Financial Interests:

    Having an interest in or an affiliation with a corporate organization does not necessarily prevent you from making a presentation, but the relationship must be made known to the audience. Failure to disclose or a false disclosure will require the American College of Prosthodontists to remove you from the program and to identify a replacement for your participation.

    I, the undersigned (or an immediate family member), have a financial interest/arrangement or affiliation with a corporate organization offering financial support or grant monies for or related to the content of this continuing dental education program as follows. There is no need to disclose the actual financial value of any affiliation.

  • Please enter the financial interest's name below, add as many as needed.

  • I understand that this form will be available for review by program participants.

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  • Affidavit of Image Authenticity

  • I, instructor for the educational program detailed above, to be presented during the 2024 Resident & Dental Student Digital Poster Competition, declare that all visual images, electronic or otherwise, used by me or my associates during this program, to the best of my knowledge have not misrepresented or falsified the treatment outcome. However if any corrections to images have been made to better demonstrate an educational topic, these corrections will be fully explained and disclosed to the audience so as to ensure that no member of the audience believes that the image presented was not in its natural state. 

    Please write N/A if there are no alterations to your images.

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  • Speaker Release Form

    Please agree to the following policies.
  • As part of its continuing education efforts, the ACP occasionally records its programs and makes those audio and video recordings, and/or edited transcriptions thereof, available to its members and other professionals interested in the topics being covered. You agree to participate in the Program described above and grant the following rights for no monetary compensation:

    You hereby grant to the ACP the following rights to your presentation for (3) three years from the date of presentation, including any written or visual material submitted in connection with the presentation(s) at the Program in any and all media or form of communication whether now existing or hereafter developed: (1) the nonexclusive worldwide right to transcribe, publish, reproduce, distribute, sell, display, or license your presentation(s), as presented in the Program, alone or in conjunction with other materials; (2) the non-exclusive worldwide right to use your presentation(s) as part of a course book or in any other publication produced by the ACP; (3) the non-exclusive worldwide right to use your presentation to promote and publicize the ACP; and (4) the non-exclusive right to use Your name, likeness and biography in connection with the advertising, publicity, and promotion of your presentation(s) and/or the ACP. This license does not change the fact that You retain copyright ownership of your presentation. Any recording of the Program is the sole copyright of ACP.

    You warrant that You have authority to grant the rights in this Agreement, that You have full power and authority to enter into this Agreement, and that your presentation(s) and any other material you submit (i) is original with You; (ii) is not subject to any third party copyright; and (iii) that publication will not libel anyone or infringe on or invade the rights of others; and (iv) that You have obtained permission from the copyright proprietor consistent with this Agreement for any third party copyrighted material used. 

    Execution of this Agreement does not obligate the ACP to publish your presentation or other materials.

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  • Speaker Provisions

    Please agree to the following policies.
  • In consideration of the ACP scheduling the aforesaid program, the Speaker hereby agrees to abide by the following provisions:


    1. The ACP is the official clearinghouse for all activities regarding the presentation. All information regarding the Speaker’s participation must be received by the ACP office and approved by the ACP by the dates specified.

    2. The Speaker’s presentation is sponsored by the ACP. Reference to co-sponsorship by an individual, group, agency, or organization other than the ACP is prohibited unless specifically authorized in advance in writing by the ACP.

    3. The presentation must be approved and scheduled by the ACP; any changes must be approved by the ACP.

    4. The speaker must adhere to the time allocation for the presentation as determined by the ACP. The ACP Annual Session Chair has the authority to end a presentation that runs overtime.

    5. Speakers are expected to present the highest quality presentations based upon published research in peer-reviewed journals. Personal opinion and unpublished research data should be stated as such if included. Derogatory commentary against other professionals or corporations is expressly prohibited. 

    6. The ACP reserves the right to cancel the Speaker’s program at any time prior to its presentation. If the ACP cancels the program, this agreement shall cease and terminate, and the Speaker understands and agrees that the ACP shall not be liable to the Speaker for any costs, expenses, or damages as a result of such cancellation.

    7. Advertising matter, commercial promotion, solicitation, or sales of any type is prohibited at any time at the ACP meeting site before, during, or after the presentation. This prohibition includes, but is not limited to, the following:

    • Distribution of commercial product materials, including brochures, flyers and product samples.
    • Direct product promotion or use of corporate branding in the Speaker’s presentation.
    • Stating Speaker’s affiliation with a commercial product or company unless disclosed to the ACP in writing prior to the presentation.

    8. The Speaker agrees to indemnify and hold harmless the ACP, its past, present, and future officers, directors, members, agents, employees from any damages that the above stated entities or persons may sustain in any manner through the Speaker’s misconduct or negligence related to the presentation.

    9. The Speaker agrees to comply with all ACP procedures governing this presentation.

    10. The ACP does not assume responsibility for any expenses in the event the Speaker fails for any reason to present the program, nor any additional travel-related expenses incurred as a result of weather, act of God, or other situation beyond the ACP’s control.

    11. The Speaker agrees that the information submitted above may be used for promotional purposes.

    12. The Speaker hereby grants the ACP permission to quote from the Speaker’s presentation in limited amounts for promotion or reporting purposes; and permission to use the Speaker’s name, photo, or other likeness in connection with any and all promotions before and after the ACP program.

    ACP Meetings Code of Conduct Policy

    ACP is committed to providing a safe, productive, and welcoming environment for all meeting participants and ACP staff. All participants, including, but not limited to, attendees, speakers, volunteers, exhibitors, ACP staff members, service providers, and all others are expected to abide by this Virtual Programs Code of Conduct. This policy applies to all ACP meeting-related events, including those sponsored by organizations other than ACP but held in conjunction with ACP events, on public or private platforms.

    ACP has zero-tolerance for any form of discrimination or harassment, including but not limited to sexual harassment by participants or our staff at our meetings. If you experience harassment or hear of any incidents of unacceptable behavior, ACP asks that you inform either Carrie Villa, Director of Finance & Administration or ACP President Dr. Lars Bouma so that we can take the appropriate action.

    Unacceptable Behavior is defined as:

    Harassment, intimidation, or discrimination in any form.
    Verbal abuse of any attendee, speaker, volunteer, exhibitor, ACP staff member, service provider, or other meeting guest.Examples of verbal abuse include, but are not limited to, verbal comments related to gender, gender identity, sexual orientation, disability, physical appearance, body size, race, religion, national origin, inappropriate use of nudity and/or sexual images in public spaces or in presentations, or threatening or stalking any attendee, speaker, volunteer, exhibitor, ACP staff member, service provider, or other meeting guest.
    Disruption of presentations during sessions, in the exhibit hall, or at other events organized by ACP throughout the virtual meeting. All participants must comply with the instructions of the moderator and any ACP virtual event staff.
    Presentations, postings, and messages should not contain promotional materials, special offers, job offers, product announcements, or solicitation for services. ACP reserves the right to remove such messages and potentially ban sources of those solicitations.
    Participants should not copy or take screen shots of Q&A or any chat room activity that takes place in the virtual space.
    ACP reserves the right to take any action deemed necessary and appropriate, including immediate removal from the meeting without warning or refund, in response to any incident of unacceptable behavior, and ACP reserves the right to prohibit attendance at any future meeting, virtually or in person.

  • Submission

    Thank you for filling out the speaker paperwork for the 2024 Resident & Dental Student Digital Poster Competition.
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