RSS Speaker Agreement Conference or Event(Required) Presentation Title(Required) Presentation Date MM slash DD slash YYYY Presentation Time Hours : Minutes AM PM AM/PM On behalf of Boston Children’s Hospital (BCH) and its Continuing Medical Education (CME) Department, we are pleased to engage you to provide and perform the Curriculum identified above as a Presenter as further described below. The terms of your engagement hereunder are as follows and by signing below you agree to the following: 1. I acknowledge that I have read the “Guidelines-Boston Children’s Hospital Online Continuing Medical Education (CME) Program” and the “Online Continuing Education (CE) Program Compensation Schedule for Online Courses used as Enduring Materials.” 2. I agree to present the Continuing Medical Education Curriculum on the date and time indicated herein. 3. The Curriculum is my own original material or material for which I have full authority to grant the rights set forth in this Program Presenter Release. 4. My assignment hereunder is granted based on BCH assurance that the Curriculum will be used for research, teaching and educational purposes only and to provide Continuing Medical Education services with or without charging a fee, and that access to the materials will be as set forth in the Guidelines-Boston Children’s Hospital Online Continuing Medical Education (CME) Program for CME enrollees unless otherwise agreed to by the Presenter. Intellectual property and copyrights in and to the Curriculum are owned by Boston Children’s Hospital however, as a Presenter, I still retain my rights in the Curriculum for my academic research, teaching, and educational purposes but without the right to offer to any other party that will offer, display, reproduce and/or copy such Curriculum for CME purposes for a fee. By signing this form, I agree to any such reproduction as described herein and agree to remove any unauthorized patient Protected Health Information and/or I will provide patient permission approval, as necessary. If you have questions about these provisions, please contact CMEdepartment@childrens.harvard.eduLearning ObjectivesRSS presenters are required to provide at least one objective for their presentations. Please enter your learning objective(s) in the spaces provided below.Learning Objective 1: This presentation will prepare learners to(Required)Click the plus sign to add more objectives. Add RemoveIs it okay to use your presentation as an enduring material in online CME course offerings? I grant permission to use my presentation in the online CME program. NameAdding your name here will act as a signature. First Last Date(Required) MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
