Controversies 2021 December 2-3, 2021The Maybourne Beverly Hills, Beverly Hills, CA Controversies 2021 Remote Faculty Details Step 1 of 3 33% Please complete the fields below for your remote faculty participation in the Controversies & Advances in the Treatment of Cardiovascular Disease: The Twentieth in the Series symposium. You will receive a confirmation email after submission with a copy of your responses.Your Name(Required) First Last Your Email(Required) Enter Email Confirm Email Mobile Phone Number(Required)Your number will be provided to the AV department in case we need to contact you during your presentation. Release FormsThe Controversies & Advances in the Treatment of Cardiovascular Disease, the Twentieth in the Series, taking place December 2-3, 2021, may videotape, audiotape, and/or reproduce portions of the symposium for the purpose of reference and/or teaching in an online format. Additionally, faculty slides will be made available online in PDF format for attendees to access after the symposium in the online meeting syllabus. Please review, complete, and submit the form below.Permission for your presentation slides to be shared with attendees in the online syllabus as a PDF(Required) YES, I give my permission to share my slides as a PDF online with meeting attendees NO, I do not give my permission to share my slides as a PDF online with meeting attendees N/A, I am not presenting slides Permission for your participation to be video and/or audio taped(Required)By choosing "YES" below, I authorize the “Controversies & Advances in the Treatment of Cardiovascular Disease, the Twentieth in the Series” symposium to videotape and audiotape my complete presentations(s) and consent to allow the use and reproduction of my name, presentation(s), and all materials contained in my presentation(s). My videotaped and audiotaped presentation(s) and materials will only be used, reproduced and distributed within the context of the conference program. To the best of my knowledge, use, and reproduction of the materials or information used in my presentation(s) will not violate any third party’s copyrights or other property rights. To the extent copyrighted or trade secret materials are used, reproduced or displayed with my presentation(s), I have obtained written permission to use, reproduce, and distribute such materials from the copyright owner. YES, I give my permission for my presentation(s) to be videotaped and/or audiotaped NO, I do not give my permission for my presentation(s) to be videotaped and/or audiotaped CRF Presentation Release FormAs part of the continuing effort by Cardiovascular Research Foundation (“CRF”) to educate and inform the medical community and the public at-large, we request your permission to post your presentation which is scheduled to be presented at the Controversies & Advances in the Treatment of Cardiovascular Disease: The Twentieth in the Series program on our Web site located at http://www.tctmd.com as well as any other web sites owned by CRF.Therefore, I hereby authorize and grant permission to CRF, its successors and assigns, to use my presentation materials for such purposes as they may choose. I understand, acknowledge and agree that CRF (i) may publish all or part of the presentations and any related handout materials in various print, electronic and internet-based media; (ii) may edit such recording for stylistic, grammatical or other purposes without affording me the opportunity to review or approve the final version; and (iii) may, in CRF’s sole discretion, decide not to use any or all of my presentation.I further authorize and grant permission to CRF to use my name, likeness, photograph and biographical data in connection with the use and/or promotion of transcripts or other materials published by CRF that include all or part of my presentation(s). It is also understood, acknowledged and agreed that I have not received and will not now or in the future receive a royalty or other monetary compensation from CRF for the rights I have granted in this Release. It is further understood, acknowledged and agreed that by signing this Release I am not prohibited from using my material in the future in either my personal or professional endeavors.Choose a formatting option:(Required) PDF - may be downloaded as an Adobe Acrobat file, but not altered PPT - may be downloaded as a PowerPoint file Permission is not granted N/A, I am not presenting slides Name - Signature(Required)Please enter your name again to provide your electronic signature. First Last Date of Signature(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Promedica International is required to keep speaker CVs in an accreditation file. Please upload your current CV in Word or PDF format.Upload Your Current CVAccepted file types: pdf, doc, docx, Max. file size: 200 MB.Thank you for completing your faculty paperwork for the Controversies 2021 symposium! You will receive a copy of this form for your records via email within 3 business days. Please click "Submit" below to finalize.
