Speakers Forms

Instructions for Completing Tx CNS 2012 Conference Speaker Forms: 

We are excited that you will be presenting a session at the 2012 Texas Clinical Nurse Specialists Conference in Austin, June 1-2, 2012. We will be offering Continuing Education credit hours at the conference and as such, our accrediting sponsor requires specific documentation be completed and returned by each speaker. 

Speaker Forms to be Completed: 

1- Conflict of Interest Form (COI) 

2- Education Documentation Form 

3- Biographical Form 

Please note: All information must be typed (with exception of check boxes and signature/date) 

For the COI form, please check any disclosures you have. Please note, for the FDA off-label statement, you must sign the form. This area is not asking if you will/will not discuss off-label uses; it only acknowledges that you will let the audience know when uses are off-label. 

Please complete the Education documentation form. Page 1&2 of an example from last year are provided as a reference. Please utilize "Taxonomy for Writing," specifically, level 5 and level 6 verbs, when writing your objectives. 

For the biographical form, please check and complete information under the "Faculty/Content Specialist."

Due Date: February 22, 2012 

Send Completed Forms to: 

Paul Pfennig at paul.pfennig@amedd.army.mil and Jeri Tidwell at jerithea.tidwell@childrens.com

When complete, send a scanned copy of the COI, Biographical form and the education documentation form to Paul and Jeri at the email addresses above. If you have any questions about completing the forms, you may contact Paul or Jeri. 

Thanks and we look forward to your presentation at the conference!

2012 Education Documentation Form - (DOC)

Biographical Form - (DOC)

Conflict of Interest Form - (DOC)

Sample Education Documentation Form Page 1 - (PDF)

Sample Education Documentation Form Page 2 - (PDF)

Taxonomy of Writing - (PDF)