PHW Presentation Request Form

The following information is required when requesting a speaker for a presentation (one form per presentation). Upon completion, PHW staff will send a confirmation email with further information. It is the requestor’s responsibility to provide the following audiovisual equipment for all presentations: LCD projector, laptop, podium, and microphone.

Note: In response to COVID-19, all PHW "live" presentations will be conducted virtually until further notice. The entity point-of-contact and attendees will be required to register through the virtual format. This format will allow attendees to join by phone or computer from any location. Further details and instructions will be given upon receipt of the presentation request. 

Full payment is due one week before the presentation. Free non-CME presentations are available for learning health systems.

Contact Person:  
Title/Department:  
Entity/Organization (include branch)/Institution:  
Address:  
City:  
State:  
Zip:  
Telephone:  
Email:  
Select one topic:  
Date of presentation:   
Platform  
Presentation start time:  


Anything we need to know?      
   

Full payment is due one week before the presentation.

Questions?  Email phw[at]texmed[dot]org

Usage of TMA Committee on Physician Health and Wellness Copyrighted Materials

[] The above named entity/organization agrees not to use slides and materials developed for the Texas Medical Association Committee on Physician Health and Wellness (PHW) (as, by their publication, they are TMA copyrighted materials) for any presentations given for non-TMA-related activities without the express written permission of TMA.  Entity further agrees not to utilize documents of the PHW to prepare materials for other entities without the express written permission of TMA.  Entity also agrees not to record, live stream or distribute a recording of, PHW presentations without the express written permission of TMA.  

[] Canceled live presentations -- If the speaker has already traveled, the above named entity/organization agrees to pay the travel expenses incurred by the speaker (mileage only) in addition to the invoice fees.

 During the COVID-19 outbreak, the above-named entity/organization agrees to the following: (i) the presentation will be provided to attendees in virtual format only; and (ii) during the presentation, attendees: (a) will not participate in a way that would violate any applicable local, state, and/or federal orders, including those related to prohibitions or limitations on public gatherings; and (b) will comply with CDC-issued guidance. The entity/organization further agrees that TMA shall have no liability for any failure by the entity/organization or an attendee to comply with applicable COVID-19 orders or guidelines.

      

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