Speaker Information

We appreciate your acceptance to speak at the 47th Annual Southeastern Consortium for Dermatology, scheduled for October 4-6, 2024, at the Boar’s Head Resort in Charlottesville, Virginia. Please complete each tab in full before submitting. If you have any questions, please contact Lauren Solyak at lsolyak@pamedsoc.org or (717) 909-2620.

*Required Field

Presentation Requirements & AV Needs

All presentations should be in PowerPoint format and should be received by Friday, Septemer 20, 2024. You will be able to make adjustments to your presentation after this date, but we will need your slides in order to provide them to the attendees for download prior to the meeting and for them to be reviewed by the CME office. Presentations can be sent to lsolyak@pamedsoc.org.

All sessions will be equipt with a laptop, microphone, slide advancer. Should you need anything additional, please indicate that below.

Presentation Title & Description

The Southeastern Consortium for Dermatology (“SEC”) wishes to place on their website, www.secderm.org, (“the website”) professional medical educational material provided in the Educational Program of the 47th Annual Southeastern Consortium for Dermatology. My Presentation will be made available to SEC members and meeting attendees in satisfaction of their CME requirements and/or for general educational professional purposes. The SEC is taking that action for primarily educational purposes and, in particular, to promote broader understanding of dermatology. The Presentation may remain on the websites for as long as the SEC deams necessary but the SEC may remove the Presentation from the website at any earlier time in their sole discretion.

I understand that I will receive no compensation from SEC for any use of the Presentation or an Altered Presentation (as defined in the following paragraph). I agree that allowing SEC to post the Presentation or Altered Presentation provides professional benefits to me. For good and valuable consideration and intending to be legally bound, I enter into this Agreement.

By signing below, I hereby authorize the usage of the Presentation described herein and agrees that SEC's usage shall not be a violation of my ownership interests, including any copyright I hold, in the Presentation. I further grant permission for SEC and any person or entity authorized by it: (i) to edit or alter the Presentation (any such edited or altered Presentation is referred to in this Agreement as an “Altered Presentation”), so long as doing so does not adversely or substantially affect the professional content; (ii) to distribute, broadcast, publish and/or transmit all or any portion of the Presentation or an Altered Presentation on its website for the purposes described above; and (iii) to use his/her name, likeness and biographical material in connection with any of the foregoing, all to the extent and in such fashion as they deem necessary or desirable to accomplish the purposes described in the first paragraph of this Agreement.

I represent that I am the owner of the copyright (solely or jointly) and have the right to permit use of the work by SEC. I further represent that to the extent that the Presentation uses any third party material in a manner that requires agreement from such third party holder to that use, I have obtained such agreement.

I hereby release SEC, it’s individual members, and those members' home institutions from any claims or liability regarding any use that may be made of the Presentation or an Altered Presentation that is authorized by this Agreement.

I have read, understand, and accept the conditions of this agreement.

I hereby give the Southeastern Consortium for Dermatology (SEC) the right and permission to copyright and/or use, publish, and reuse and republish photographic pictures or portraits made of me, with or without my name, in connection with the above-identified subject, through any media and for whatever lawful purpose the company chooses in perpetuity. 

I hereby release, discharge and agree to save harmless the SEC, their representatives, employees, or any person or persons, corporations, acting under the permission of the company, including any firm publishing or distributing the finished product, even though the finished product may be blurred, altered, distorted or used in composite form, either intentionally or otherwise.

I hereby waive any right to approve the finished photograph or any copy that might be used in conjunction with the finished photograph.

I hereby warrant that I am over 21 years of age, and am competent to contract in my own name, insofar as the above is concerned.

I have read the foregoing release, authorization and agreement before affixing my signature below, and warrant that I fully understand the contents thereof:

 You are required to complete a financial disclosure form. Please submit the form to be redirected to the online disclosure form.

Title of CME Activity: 47th Annual Southeastern Consortium for Dermatology Conference
Date of Activity: October 4, 2024

Thank you!