May Owen, MD, Outreach Program Application

May Owen, MD, Outreach Program Application
May Owen, MD, Outreach Plan

The May Owen, MD, Outreach Program is a grant program of the TMA Women Physicians Section (TMA-WPS) that provides funding to bring female physician-oriented programs and activities to small and mid-sized county medical societies.

The application is open year-round; however, funding is available only once a year to each organization. Funding is variable per event and approval, and will not exceed $750. Discretion to add to the maximum amount of funding will be up to the application review and approval committee. Any cost accrued over the funding provided through the grant must be covered by the county society.

General overview
- Funding is available to small and mid-size county medical societies with at least 80 members; in some cases programs can be in collaboration with a metro county medical society.
- Applicants must guarantee physicians attendance of at least 15.
- The grant funding will be provided as a reimbursement. Reimbursement will not exceed the amount approved during the application process.
- An applicant’s previously scheduled women physicians’ events, including annual events, are not eligible for grant funding.
- TMA Insurance Trust is a pinnacle sponsor of this program. Events that have additional sponsors are ineligible for grant funding.
Applicants agree to:
- Coordinate all logistics and promotion for the event, place TMA and TMA Insurance Trust logos on all promotional materials, and display thank you signage and distribute branded collateral provided by TMA.
- Answer a brief report/survey and submit a reimbursement form with receipts and an attendance report. The attendance report should include the full name, email address, and TMA member ID or medical license number for each physician attendee.
- Follow all CME guidelines if providing an ACCME accredited CME presentation.
WPS Outreach Program webpage contains resources for hosting a successful event including event tips, timelines, and advertising templates to personalize your event.

TMA staff will mail branded collateral to distribute to your attendees and cobranded thank you signage to be displayed.

Please complete the information below to apply for the TMA-WPS May Owen, MD Outreach Program.
Event Contact*

First NameLast Name
Title*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com

Your expected attendance numbers will be used when packaging branded collateral.
Event Name*
Event Date*

MonthDayYear
Date
Event Time*
Event Location*
Requested Amount*
Enter the amount in whole dollars. Funding will not exceed $750. Please request on the funds which are necessary for the event.
Type of Event*
Program/Event Description*
Provide a brief overview of your event
Expected Attendance*
List the program you are interested in scheduling:*
For your presentation, will you use a TMA speaker or find your own speaker?*
If you want to schedule a TMA speaker, please complete this form. You must login to TMA website to access this form.
If you are using your own speaker, please provide the presenter’s name and title, and the presentation title*
Presenter's Name and Title; Presentation Title
Should be Empty: