Webinar Speaker Information - American College of Apothecaries

Thank you for agreeing to present a webinar for ACA. Please complete the speaker agreement below. We have also provided the webinar slide template below. If you have any questions, please contact cesupport@acainfo.org.

Webinar Information

The Activity Planning Chart & Gap Analysis Chart are required resources to help fill out speaker agreement. Please submit with Speaker Agreement when done. ↓ Download Activity Planning Chart ↓ Download Gap Analysis Chart
Your PowerPoint presentation is due to ACA no later than 1 week prior to your webinar date. ↓ Download PowerPoint Template
You must have hardwired internet access to present your webinar.
Our webinars are hosted through zoom and we will contact you prior to your webinar date to do a practice run and explain how the process goes.
ACA Staff will be on the live webinar to introduce you, read the disclaimers, explain to the attendees how to ask questions, and provide technical support.

Webinar Speaker Agreement

Please submit this completed agreement. This agreement, made between the Speaker and the American College of Apothecaries.

"*" indicates required fields

Step 1 of 4

Policy of Non-Commercialism

ACA maintains a policy of non-commercialism in accordance with the Accreditation Council for Pharmacy Education, that states “Continuing pharmacy education activities that provide an in-depth presentation with fair, full disclosure as well as objectivity and balance.

Appropriate topics and learning activities shall be distinguished from those topics and learning activities that are promotional or appear to be intended for the purpose of endorsing either a specific commercial drug or other commercial product (as contrasted with the generic product/drug entity and its contents or the general therapeutic area that it addresses), or a specific commercial service (as contrasted with the general service area and/or the aspects or problems of professional practice that it addresses).”

Conflict of Interest Disclosure and Equitable and Fair Balance Agreement*

As a speaker and/or continuing eduaction faculty member, I will:

a) ‘Meaningfully disclose’ any relevant interests that may affect the content of the educational activity being offered.
b) Identify and resolve all conflicts of interest prior to the educational activity being delivered to learners.
c) Ensure the content of the educational activity will give a balanced view of therapeutic options to promote improvements or quality in healthcare and not specific proprietary business interests of a commercial interest.

Balanced view means that recommendations or emphasis must fairly represent, and be based on, a reasonable view and valid interpretation of the information available in the subject and that no single product or service is over represented in the educational activity when other equal but competing products or services are available for inclusion.

We collect information from all planners, faculty, and others in control of educational content about all their financial relationships with ineligible companies within the prior 24 months. As defined by ACPE, an ineligible company is one whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. There is no minimum financial threshold; individuals must disclose all financial relationships regardless of the amount, with ineligible companies.

Exception: Accredited providers do not need to identify, mitigate, or disclose relevant financial relationships for accredited education that is non-clinical, such as leadership or communication skills training.

I agree to supply this information.

I have been informed that my presentation falls into the exemption above.

Download Financial Relationship Disclosure Form For Planners, Faculty, And Others

Financial Relationship Disclosure Form for Planners, Faculty, and Others**

Please upload your completed and signed financial Relationship Disclosure Form below.

Accepted file types: pdf, jpg, png, Max. file size: 200 MB.

Compensation/Reimbursement Policy

Under the terms of this agreement, speakers will receive compensation as follows:

• Receive - $150 Honorarium per 1-hour webinar

• Donate to the ACA Foundation - $150 Honorarium per 1-hour webinar

A signed copy of this Speaker Agreement must be submitted within 10 days of the email. Failure to return this Speaker Agreement will result in the delay and/or loss of compensation.

I would like to:*

Receive the $150 Honorarium

Donate the $150 Honorarium to the ACA Foundation

Decline any Honorarium

Other - See Speaker Agreement Amendment

Download Request for Taxpayer Identification Number and Certification

W-9*

Please upload your completed and signed W-9 below.

Accepted file types: pdf, jpg, png, Max. file size: 200 MB.

Funds Disbursement

ACA agrees to disburse all monies due to the Speaker no later than 6 weeks after the conclusion of the Webinar. The Speaker is an independent contractor and will pay all applicable state, local and federal taxes associated with this Agreement. Due to ongoing issues mail security and delivery issues with the USPS, we offer electronic payment delivery. Speakers selecting this option should complete the attached Authorization for Direct Deposit Form and return it, along with an image of a voided check, to cesupport@acainfo.org.

Speaker requests that applicable compensation/reimbursement be made to:*

Make check payable to:

Method of Payment**

Physical Check

Direct Deposit

Download Authorization for Direct Deposit.

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hidden

Social Security # / Tax ID #:

Productive Work Environment Policy

It is the policy of ACA to promote a productive work environment and we will not tolerate verbal, physical or other conduct by an employee, agent, contractor, consultant, or representative of the Association that discriminates, harasses, disrupts, or interferes with another’s work performance or that creates an intimidating, offensive, or hostile environment.