IDSA Request Form: Physician Compensation Initiative Live Learning Sessions
This form can be used to request a
Physician Compensation Initiative
Live Learning Session from the Infectious Diseases Society of America.
Guidelines & Information
Time Frame
Requests should be made at least 90 days prior to the event
We are unable to accommodate requests made more than 6 months in advance
Cost
No fees, stipends, or honoraria are required
Miscellaneous
An agenda of the event is requested (draft agendas are acceptable)
Contact Information
Sponsoring Organization:
Mailing Address
(Street, City/Town, State and Zip Code)
This will be an address where any swag or paraphernalia can be sent
Contact Name:
Contact
Title:
Contact
Email:
Contact
Phone:
Website address (if applicable):
Event Information
Event Name:
Start Date (MM/DD/YY) & Time:
End Date (MM/DD/YY) & Time:
Location:
Theme/Purpose of Event:
(CME, Annual Meeting, Symposium, etc.)
Speaker Start Time:
Length of time allotted for presentation:
The PCI Roadshow Live Learning Events are held online. Are you able to provide IDSA with a calendar invite for the event, including a link to your organization's web conferencing platform (e.g., Zoom/ WebEx)?
Please select...
Yes
No
Expected Attendance (#):
Invited Audience:
ID Physicians
Fellows
Students
Other
Check all that apply
Explain other invited audience
Please share any potential pain points around compensation specific to your locality.
Please indicate whether the invited audience is:
Pediatric care-focused
Adult care-focused
Both pediatric and adult care-focused
Presentation Specs
Presentation Format:
Keynote/General Address
CME Presentation
Panel
Roundtable
Other
Please specify:
Will the following AV equipment/services be available? (check all that apply)
LCD Panel/Screen
Computer/Laptop
AV Support
Do you need us to supply any of the following? (check all that apply)
Speaker Bio
Speaker Headshot
Speaker Slides/Presentation
Please provide a copy of your draft agenda
Would you be open to sharing an attendee list with IDSA after your event?
Yes
No
Would you be open to sharing pictures and/or a recording link from the event?
Yes
No
Other Setup (please explain)