Webinar Speaker Information - American College of Apothecaries

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Thank you for agreeing to present a webinar for the American College of Apothecaries! Please complete the Speaker Agreement form below. We’ve also provided the ACA webinar PowerPoint slide template to help guide the development of your presentation and ensure consistency across our programs. If you have any questions or need assistance, feel free to contact us at cesupport@acainfo.org. We appreciate your contribution and look forward to your presentation.

Webinar Information

The Gap Analysis Chart and Activity Planning Chart are required documentation for ACPE-accredited continuing education activities. These tools help ensure the educational content is evidence-based, addresses identified professional practice gaps, and aligns with learning objectives and outcomes. Completion of these documents is necessary to meet ACPE standards for CE accreditation and to maintain the integrity and quality of the educational program. Please submit with Speaker Agreement when done. ↓ Download Gap Analysis Chart ↓ Download Activity Planning Chart
Your PowerPoint presentation is due to ACA no later than 2 weeks 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

Speaker Information

First and Last Name*

Degree*

RPh

PharmD

PhD

Other (answer below)

Other Degree

Job/Position Title*

Company/Pharmacy/Organization*

Address*

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

Email*

Cell Phone*

Fax Number

Date of Webinar*

We recommend a Tuesday, Wednesday or Thursday.

Use date format - mm/dd/yyyy

Time of Webinar*

We recommend 10 AM - 1 PM

Time Zone*

Presentation Information

Speaker agrees to provide a webinar presentation for the ACA in accordance with the learning objectives and course description for the program. The speaker’s presentation must meet with this criteria.

Please list presentation title and your name with credentials as you would like them in print:*

Activity Description*

Please provide a short (3-4 sentence) description of what need this presentation will address for pharmacists and/or pharmacy technicians. How your presentation will lead to better business practices or patient care?

Please specify the intended audience. (150 words)

Which learning assessment component(s) do you plan to present? (select all that apply)

Knowledge-Based CPE Activity: This type of continuing pharmacy education (CPE) activity is intended to provide pharmacists and pharmacy technicians with factual, evidence-based information. Content should be supported by literature and widely accepted within the healthcare professions. The webinar will include informal audience engagement. Please plan to reserve a brief Q&A session at the end of your presentation to address participant questions.

Polls/Quizzes

Group Discussion

Case Studies

Observations

Fill-in activities

Paired Practice (role playing)

Requirements for CE Presenters

The checklist below outlines information necessary for each presentation. This information complies with the Accreditation Council for Pharmacy Education (ACPE) standards. Please complete this checklist, along with your introductory bio, photo and your Financial Relationship Disclosure Form within 10 days of receipt of this agreement.

Learning Objectives

Please list 3-4 learning objectives for each session.

• Objectives are written in behavioral terminology and should suggest specific and measurable outcomes for an activity’s success or effectiveness. (Examples – Discuss, Describe, Identify, Compare, etc.)

• The following words should be avoided when writing learning objectives because they do not enable measurement:
Be familiar with, Be aware of, Comprehend, Conceive, Figure out, Grasp, Handle, Imagine, Know, Learn, Master, Realize, Remember, Think, Understand

• For more assistance in writing SMART learning objectives, please refer to Bloom’s Taxonomy for Writing Learning Objectives.

•You will be evaluated by attendees based on the below objectives:

Target Audience — Select one option below*

If both pharmacists and pharmacy technicians are part of the target audience, the learning objectives should be appropriate for each profession, either through an appropriate shared set, or individual objectives for each group.

The same Learning Objectives are appropriate for both Pharmacists and Pharmacy Technicians

Pharmacists and Pharmacy Technicians will have separate sets of Learning Objectives

Learning Objectives - Pharmacists and Pharmacy Technicians*

Describe what the Pharmacist AND Pharmacy Technician can expect to know or be able to do after completion of the CPE activity.

Learning Objectives - Pharmacists*

Describe what the Pharmacist can expect to know or be able to do after completion of the CPE activity.

Learning Objectives - Pharmacy Technicians*

Describe what the Pharmacy Technician can expect to know or be able to do after completion of the CPE activity.

Topic Designators — Activities are related to:*

Which one of these nine areas do you expect your presentation will address?

01: Disease State Management/Drug Therapy - activities that address drugs, drug therapy, and/or disease states.

02: HIV/AIDS - activities that address therapeutic, social, ethical, or psychological issues related to the understanding and treatment of patients with HIV/AIDS

03: Law Related to Pharmacy Practice - activities that address federal, state, or local laws and/or regulations affecting the practice of pharmacy.

04: Pharmacy Administration - activities that address topics relevant to the practice of pharmacy that include the economic, social, administrative and managerial aspects of pharmacy practice and health care.

05: Patient Safety - activities that address topics relevant to the prevention of healthcare errors and the elimination or mitigation of patient injury caused by healthcare errors.

06: Immunizations - activities related to the provision of immunizations, i.e., recommend immunization schedules, administration procedures, proper storage and disposal, and record keeping. This also includes review for appropriateness or contraindication and identifying and reporting adverse drug events and providing necessary first aid.

07: Compounding - activities related to sterile, nonsterile, and hazardous drug compounding for humans and animals. This includes best practices and USP quality assurance standards, environmental testing and control, record keeping, error detection and reporting, and continuous quality improvement processes.

08: Pain Management - activities that address any component regarding the treatment and management of pain, including the prescribing, distribution and use of opioid medications, and/or the risks, symptoms, and treatment of opioid misuse/addiction.

99: Additional Topic Areas - activities related to topics relevant to the practice of pharmacy not included in the classifications of the topic designators 01-08.

Additional Educational Materials

In addition to your PowerPoint presentation, you must include at least 2 additional sources of educational materials as a means to enhance participant understanding of content and foster applications to practice (eg. reference tools useful in practice, reference links, literature studies, informational guidance, supplemental handouts, etc.)

Supplemental Handouts for Attendees

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 1 GB.

Video/Audio Recording

Your session may be recorded and distributed by ACA in audio, video, or print format. Recordings may be shared via the ACA website, third-party platforms, or the ACA Education Center online library. By participating, you consent to ACA recording and distributing your presentation under copyright law (Title 17, U.S. Code). All royalty claims are waived. Recordings may not be distributed by others without your written permission.

Video/Audio Recording Consent*

I Give My Consent

Presentation Objectives and Fair Balance Agreement

The American College of Apothecaries is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education and will be providing the accreditation for the educational programs developed at this seminar. To help us maintain compliance with ACPE, please review the requirements below as well as the associated deadlines for submission.

Presentation Materials/Guidelines

Speakers must submit one (1) PowerPoint presentation (max 30 slides per 1-hour session) using the official ACA webinar template. This presentation will be shared with attendees on the event website.

1. Use the ACA Webinar PowerPoint template.
2. Title font: Calibri Bold 44 (black); Body font: Arial 28 (black); minimum font size: 18 pt.
3. Submit slides and handouts electronically.
4. Include any supplemental materials (e.g., articles, sample forms).
5. Add a bibliography if referencing specific studies.
6.No commercial content is allowed.
7. Do not include videos.
8. Avoid endorsing specific pharmacies or copycat products.
9. Do not suggest price comparisons that could imply collusion.
10. Submission Format: Send your PowerPoint file as an email attachment to cesupport@acainfo.org. Files must be PC-compatible (no Macintosh formats Please note: final presentation materials must be received no later than 2 weeks prior to the webinar date.

Photograph Requested

To help us market and promote your session, we would like you to provide an electronic photograph in .JPG or .PNG format. This photo will be used in promotional material about the session, on the web page, and onsite materials. Please submit a photo for use within 10 days of receipt of this agreement. The photo may be uploaded below or emailed to cesupport@acainfo.org.

Upload Photograph

Accepted file types: jpg, png, Max. file size: 1 GB.

Introductory Bio

Please provide a brief paragraph format biography in a Microsoft Word document within 10 days of receipt of this agreement. This biography will be used for promotional purposes to inform potential program participants. Upload your bio below or email your biography to cesupport@acainfo.org.

Upload Your Bio

Accepted file types: doc, docx, Max. file size: 1 GB.

Policy of Non-Commercialism

ACA follows ACPE guidelines to ensure all continuing education activities are objective, balanced, and free from commercial influence. Content must not promote or endorse specific commercial drugs, products, or services, but instead focus on evidence-based, educational information relevant to professional practice.

Conflict of Interest Disclosure and Equitable and Fair Balance Agreement*

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

a) Disclose any relevant financial relationships that may impact the content of the activity.
b) Identify and resolve all conflicts of interest before the activity is presented.
c) Ensure content is balanced, evidence-based, and not influenced by commercial interests.

A balanced view means all reasonable therapeutic options are fairly represented without favoring specific products or services when alternatives exist. ACPE requires disclosure of all financial relationships from the past 24 months with ineligible companies—those primarily involved in producing, marketing, or distributing healthcare products used on patients. There is no minimum threshold; all relationships must be disclosed.

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.

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

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

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; or
• 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

W-9*

Please upload your completed and signed W-9 below. Download W9

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

Authorization For Direct Deposit

Please upload your completed and signed Authorization For Direct Deposit below. Download Authorization for Direct Deposit Form

Max. file size: 1 GB.

Mailing Address*

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

This field is hidden when viewing the form

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.

Cancellation

In the event the webinar is cancelled for which the Speaker has been hired, no compensation will be provided to the Speaker.

Terms

I have read the terms of this Speaker Agreement between ACA and myself for the Webinar and agree to the terms presented. There are no other terms or conditions to my engagement other than those written here. There can be no changes unless agreed to in writing. Failure to complete this Speaker Agreement will result in the loss of compensation. Failure to comply with the handout requirements described in the Presentation Materials section above will also result in the loss of compensation.

Signed*

Type Full Name

Date*

Comments

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