Webinar Proposal Form

Name of requesting ACVP committee or group

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First name of committee or group contact

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Last name of committee or group contact

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Email of committee or group contact

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Proposed webinar topic/title

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Brief description/abstract for webinar and why/how it would benefit the ACVP community (1-2 paragraphs)

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List of proposed speaker(s) and their credentials

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Target audience for this presentation (anatomic pathologists, clinical pathologists, pathologists with a particular area of interest, trainee members, etc.)

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Target month or time of year for the webinar

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Is the above timing flexible? If yes, note alternative timing below.

Yes

No

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Alternative month or time of year for webinar

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ACVP webinars are a member benefit — planned by members, for members. If your group would like ACVP leadership to consider allowing promotion of the webinar to a wider audience and/or sharing the recorded content with a wider audience, please list the specific request and the reason for the special consideration in response to the next, optional question.

I understand.

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Request and justification for promoting to and/or sharing recorded webinar content with a wider audience.

ACVP webinars are presented as 60-m,inute Zoom webinars, with presenters being the only participants who can speak, be seen, and/or share their screens. Webinar attendees may only post to the chat to interact with other attendees and post questions for the presenter(s) via that Q&A box. If your group would like ACVP leadership to consider allowing and facilitating any other set up, please list the specific request and the reason for special consideration in response to the next, optional, question.

I understand.

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Request and justification for special arrangements such as break-out rooms or enabling participant video or audio participation:

ACVP offers RACE and MOC credit for pathology-based, scientific webinars. Would the proposed webinar qualify for RACE credit?

Yes

No

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ACVP offers $250 speaker honorarium per webinar. No honorarium is provided for panel discussions. Would you like to offer honoraria to the proposed presenter? (If your group would like ACVP leadership to consider providing any extraordinary honoraria, please list the specific request and the reason for the special consideration in response to the next, optional question.)

Yes

No

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Request and justification for extraordinary honoraria: