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CLEC Faculty Agreement

The Clinical Laboratory Educators' Conference (CLEC) is a partnership between you, other faculty, the American Society for Clinical Laboratory Science (ASCLS), and its CLEC Program Committee to provide continuing education and networking opportunities for lab administrators, directors, supervisors, staff, educators, students and others in the field of clinical laboratory science.  We are eager to publicize your participation in the CLEC program.  We will appreciate both your cooperation in providing necessary information and your compliance with all program deadlines.  Please review the following information, and submit your electronic signature by September 29, 2017.  By submitting your information below, you understand and accept the terms of your participation as stated in this agreement.  If you have any questions, please email speakers@ascls.org or call Pam Magnani at 703-679-2016. 

This agreement confirms that the faculty member will:

  • Plan and present the CLEC session described in your speaker invitation email.  Faculty online agreement must be received by September 29, 2017.  If it is not received by this date, you may be required to forfeit this speaking invitation.
  • Submit one original of all handout materials by Wednesday, January 31, 2018.
  • Submit one original PowerPoint presentation by Wednesday, January 31, 2018.
  • Provide ASCLS with written permission for any copyrighted materials not owned by the speaker, which are included in the speaker’s presentation and handouts. Beyond “fair use,” copyrighted materials must not be included in presentations or handouts without written permission from copyright holders. Faculty member agrees to indemnify and hold ASCLS harmless against any claims relating to copyright infringement.
  • Faculty member agrees to provide ASCLS with an unlimited, non-exclusive license to record, store, and distribute content delivered by faculty members as part of this speaker agreement.

ASCLS will provide the following:

  • Distribution of handout materials as stipulated in the Faculty Guidelines and Information.
  • Uploading of presentation to AV equipment prior to speaker's session (if submitted to ASCLS by January 31, 2018)

FACULTY GUIDELINES

  • GENERAL SESSIONS, BREAKOUT SESSIONS (including HOT TOPICS) and ROUNDTABLE SESSIONS:  
    • These sessions are open to all conference attendees and qualify for P.A.C.E.® continuing education credits.
  • AUDIO VISUAL EQUIPMENT:  
    • Meeting rooms will be equipped with an LCD projector, a screen, cables and laptop. Please notify Pam Magnani at speakers@ascls.org by December 31, 2017 if you require any equipment other than the items indicated above.  It will not be possible to make equipment changes on site. We will do our best to accommodate your needs.
  • ROOM SET-UP: 
    • Most sessions will be set classroom (tables and chairs) with the possible exception of the general sessions which may be set theater (chairs only).  Roundtables will be set as tables of 10 inclusive of the speaker.
  • REGISTRATION:  
    • Faculty who have accepted our speaking invitation and are interested in attending CLEC may do so compliments of ASCLS (one-day registration only).  Registration will be available online November 1, 2017.  A discount registration code will be provided for you to register online.
  • HONORARIA:  
    • Faculty will receive honoraria as stipulated in individual faculty invitations.
  • LODGING:  
    • Faculty are responsible for making their own lodging arrangements at the Royal Sonesta Hotel in Houston, TX.   Please do so prior to January 30, 2018 to obtain the group rate.  Information is available in the CLEC brochure or the CLEC website.
  • HANDOUTS:  
    • ASCLS provides a pre-meeting handout website, where your electronic handout will be posted.  This enables participants to preview all sessions and pre-print their own handouts. Submit handouts via CLEC Speaker Presentation website by January 31, 2018.
  • POWERPOINT PRESENTATION:  
    • In order to ensure audio and visual success, ASCLS requires that one PowerPoint presentation be submitted via the CLEC Speaker Presentation website by January 31, 2018.  The slides should be uploaded as a .ppt or .pptx file.  Please do not submit slides in PDF format.  Should you update your PowerPoint presentation after January 31, 2018, you are responsible for bringing the updated version on a USB thumb drive.
  • W9 FORM: 
    • A W9 form will be sent to you upon completion of your online speaker forms.  If you are receiving a speaker honorarium, ASCLS must have a W9 form on file to issue an honorarium check. Please complete the form and return it via speakers@ascls.org by October 6, 2017 to insure you receive your check onsite.

ASCLS RESERVES THE RIGHT TO CANCEL THIS AGREEMENT IF FACULTY FAILS TO SUBMIT THE AGREEMENT AND OTHER APPROPRIATE COURSE INFORMATION BY THE SPECIFIED DATE.

The foregoing is in accordance with my understanding of our agreement.  Amendments or changes to this agreement must be made in writing and must be signed by all parties.  


FINANCIAL DISCLOSURE

The possibility for bias or a conflict of interest occurs when the financial interests of a speaker/author potentially preclude an unbiased, scientific presentation of a subject. The disclosure of possible conflict of interest is requested not to censor or exclude speakers, but to inform the audience so they may decide for themselves whether or not a presentation is biased. Information from this declaration will be disclosed to participants as follows: “Dr. Smith has research support from ABC Technology, Inc.” but will not be used to exclude speakers from an activity.

ASCLS requires all speakers in accredited Continuing Education Activities to disclose any possible bias or conflict of interest regarding the topic that is being presented. A conflict of interest is defined as any financial interest of the speaker in a company's products or services discussed in the presentation. For example, if the speaker (1) holds stock in the company, (2) is paid salary or consultant fees by the company, (3) has grant support from the company, and/or (4) has received support for travel expenses, honoraria, etc., from the company, a conflict of interest exists regarding this topic and must be reported. If the speaker has a financial interest in a company but is not discussing a product or service of that company, no conflict of interest must be disclosed. 

Please complete the statement below as it relates to the topic of your presentation within the preceding 12 months.

Required fields are indicated with an *.
  1. Disclosure Statement

    I have read the above statements and (please check the appropriate box below; required field)
  2. (*)

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  3. Financial Interest Disclosure
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  5. Company(ies)
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  6. Invalid Input
  7. Company(ies)
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  8. Invalid Input
    Do not include mutual funds.
  9. Company(ies)
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  10. Invalid Input
  11. Company(ies)
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  12. Faculty Information

  13. Speaker First Name(*)
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  14. Speaker Last Name(*)
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  15. Speaker Credentials(*)
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    Limit to highest advanced degree earned and one certification of your choice. Board of Certification (BOC) credentials must be consistent with BOC guidelines - www.ascp.org/boc.
  16. Professional Affiliation(*)
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    List your professional affiliation as you would like it to appear in the program (Note: only one institution or company name will be listed in the program.) Please only list your institution; do not include your title.
  17. Speaker Introduction(*)
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    Provide pertinent information (experience, research, publications or presentations) that relates to this session/topic. This background information will be used to introduce you. Please limit biographical information to 50 words or less.
  18. Mailing Address(*)
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    Please provide a mailing address for official speaker correspondence.
  19. Speaker Email Address(*)
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  20. Speaker Mobile Phone(*)
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  21. Presentation Title(*)
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    Limit to 50 characters. Please exclude all special characters, such as !, ?, &, $.
  22. Program Description(*)
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    Be as specific as possible. Program description must be limited to 50 words or less.
  23. Learning Objective 1(*)
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    Provide 3 different learning objectives for your presentation by completing this sentence: “At the conclusion of my presentation, participants will be able to….” Learning objectives must be measurable, so please begin with words like “Identify”, “classify”, “summarize”, etc. Please refrain from beginning objectives with the verbs "understand," "learn" or "know."
  24. Learning Objective 2(*)
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  25. Learning Objective 3(*)
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  26. Faculty Agreement

  27. Click here to confirm(*)
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