Audio Visual Equipment Request Form

Healthcare Financial Management Association – Region 9 HFMA Region 9 Conference | November 15-17, 2015

PRESENTER AGREEMENT

EVENT: HFMA REGION 9 CONFERENCE

PRESENTATION DATE/TIME:NOVEMBER __, 2015 | _:__ AM/PM

PRESENTATION TITLE: “PRESENTATION TITLE”

PLACE: Sheraton New Orleans | 500 Canal Street | New Orleans, Louisiana 70130

PRESENTER: PRESENTER NAME

Please review the following information. Sign and submit this agreement to the HFMA Region 9 (HFMA REGION 9) Conference Director, Dean Newton. If you have any questions about this information, please contact Dean Newton at 713.776.1314 or email [email protected].

PRESENTATION INFORMATION Along with this Agreement, please submit the following information in electronic format upon receipt:

Presentation Title (final title to be used in promotional materials) Topic Description (a short description of the material to be covered) Learning Objectives (a description of what attendees will learn from the presentation) Target Audience (who should attend and will benefit from the presentation Presentation Level (Basic, Intermediate, Overview, Strategic, Advanced) Presenter Biography (a short bio to be used during introductions and in promotional material) Recent Photo (head and shoulders photo in .jpg format)

All information to be returned to: HFMA Region 9 | PO Box 631206 | Houston, TX 77263-1206 [email protected] | Tel 713.776.1314

PRESENTATION VISUAL AIDS and HANDOUT MATERIALS In order to provide Continuing Professional Education (CPE) credits for CPA’s, HFMA Region 9 is required to retain copies of all presentations and handout materials. If you will be using a PowerPoint presentation, please email a copy of the presentation to [email protected] no later than November 1, 2015. HFMA Region 9 Conference does not provide printed copies of handouts at the conference. Your presentation will be converted to .pdf format and posted to the conference website for download by attendees. The presentation will be maintained on the website for 60 days following the conference.

MEETING REGISTRATION HFMA Region 9 will provide the Presenter with one complimentary meeting registration for the Event. Please register at www.hfmaregion9.org and select the “Complimentary Speaker or Sponsor” option under “Payment”. This allows us to insure we have correct contact information and to determine which conference events you will attend.

AIRLINE/TRAVEL ARRANGEMENTS You are responsible for air and other travel arrangements. HFMA Region 9 will reimburse reasonable cost for coach class air travel to the New Orleans airport. Please book your reservations early to ensure the lowest coach fair. If you are driving to the event, HFMA Region 9 will reimburse mileage at the Internal Revenue Service standard rate in effect at the time of the Conference. HFMA Region 9 will reimburse the cost of taxi or shuttle service between the Austin airport and your hotel (please retain receipts). Healthcare Financial Management Association – Region 9 HFMA Region 9 Conference | November 15-17, 2015

HOTEL ARRANGEMENTS Please make your own reservation at the Sheraton hotel in New Orleans, LA. You are urged to make your reservations immediately as our room block will sell out early. HFMA Region 9 will reimburse your room and tax for one (1) night’s stay at our group rate at the Sheraton. If you stay in a different hotel, HFMA Region 9 will reimburse for one (1) night at the actual rate paid or the HFMA group rate, whichever is less. Any additional nights and all incidental hotel expenses will be the responsibility of the Presenter. Should the logistics of your travel arrangements or presentation time(s) make it necessary to stay an additional night, please contact Dean Newton at [email protected] and we will make every effort to accommodate you.

FOOD/BEVERAGE HFMA Region 9 will reimburse up to a maximum of $75.00 (with receipts) for food and beverage. Please be aware that breakfasts, breaks, and a luncheon are provided by the conference per the published conference agenda.

EXPENSE REIMBURSEMENT FORM Please submit reimbursable expenses, with copies of receipts, to HFMA Region 9 using the attached Speaker Expense form. Please submit your expenses no later than December 31, 2015 – after that date we will consider your expenses as a donation to HFMA Region 9.

AUDIO VISUAL EQUIPMENT Conference meeting rooms are equipped with a Laptop Computer, LCD Projector, Screen, Wireless Lapel Microphone, Podium Microphone, and Audio Out cable. If any other AV equipment is needed, please contact HFMA Region 9 no later than November 1, 2015.

OVERVIEW OF AGREEMENT HFMA Region 9 agrees to the following terms:  One complimentary full meeting registration for Presenter.  Reimbursement of coach air travel expenses – (reservations to be made by the Presenter as early as possible) or reimbursement of mileage to the conference at the prevailing IRS rate.  Reimbursement of hotel fees and tax for Presenter for one (1) hotel night at the HFMA standard group room rate and tax, or the actual price paid, whichever is less. Please make your own reservations as early as possible.

PRESENTER CHECKLIST [ ] Fax or mail this signed agreement to the HFMA Region 9 Conference Coordinator [ ] Send (upon receipt and via email) the information requested under “Presention Information”, above. [ ] E-mail PowerPoint presentation to Conference Manager November 1, 2015. [ ] Make your hotel and travel reservations.

I have read and fully understand the information above. I agree to speak at the 2015 HFMA Region 9 Conference in New Orleans, Louisiana and to abide by the terms listed above.

______/____/____ Presenter Signature Date

______Print Name Address City/State/Zip

______Telephone Fax Mobile Phone Email Address Healthcare Financial Management Association – Region 9 HFMA Region 9 Conference | November 15-17, 2015

Presenter Information Form

Please return complete information by July 1, 2015 HFMA | PO Box 631206 | Houston, TX 77263-1206 | [email protected] Tel: 713.776.1314 | Mobile: 832.859.2812

Presenter Name:______Company/Organization:______Title/Position:______Address:______City/State/Zip:______Phone:______Fax:______Cell:______Email:______Administrative Assistant Name/Email: ______

Presentation Date:______Time: Begins______Ends______

Topic Information: The following information is required to be included in our printed and on-line promotional materials in order to maintain our ability to offer CPE hours through the National Association of State Boards of Accounting.

Topic Title – to be used in our printed and on-line promotional material:

______

Topic Description – A brief summary of the topic, no more than 3 or 4 sentences:

______

Target Audience (who should attend)

______Healthcare Financial Management Association – Region 9 HFMA Region 9 Conference | November 15-17, 2015

Learning Objectives – After this session, attendees will be able to:

Topic Level: Please circle one - Basic Intermediate Advanced

Prerequisites (if level is above Basic): Example: “An understanding of healthcare finance ….”, “Basic knowledge of …….”

Presenter Background: Please attach a brief background of the presenter including qualifications to present the topic material (no more than two paragraphs). This will be displayed in print and on-line materials. Please do not send a Curriculum Vitae (CV) or detailed resume.

Presenter Introduction: Please attach a very brief paragraph to be used during the presenter’s introduction at the conference.

Speaker Photo: Please provide a color head & shoulders photo, in a high-resolution, digital format (.jpg or .png). Please do not send photos embedded in word processing (.doc) or Acrobat (.pdf) files. Photo may be emailed to [email protected].

Audio/Visual Equipment: The meeting room will be equipped with an LCD Projector, Laptop Computer with Powerpoint, Screen, Wireless Lapel Mic, Podium & Podium Mic. If you have any additional A/V needs, please detail below.

Presentation File and Handouts: We are required to maintain a copy of all presentations and handouts for CPE accreditation purposes. HFMA Region 9 will post all presentations and handouts for download on our website as .pdf files during the week leading up to the conference, and for one month following the conference. Please provide a digital file of your presentation/handout for posting by November 1, 2015. Please provide a final digital file to be preloaded on the computer in the presentation room no later than November 10, 2015.

Travel & Lodging: A full description of our reimbursement policies is contained in the Speaker Agreement. In general, HFMA Region 9 Conference will provide complimentary conference registration and will reimburse one night in our conference hotel (the Sheraton New Orleans) at our group rate. We will also reimburse your travel expenses including coach class airfare, taxi or shuttle, parking, tips and up to $75 per day for meals (with receipts). If your travel arrangements require that you spend more than one night, please contact Dean Newton ([email protected]) to discuss – we will make every effort to accommodate you.

Contact: If you have any questions, please contact your topic coordinator: ______

Conference Manager: Dean Newton, [email protected], 713.776.1314