Controversies 2021 December 2-3, 2021The Maybourne Beverly Hills, Beverly Hills, CA Faculty Hotel, Presentation Release, and Faculty Dinner Form Step 1 of 5 20% Please complete the fields below for your 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 Travel InformationPlease make your own airline reservations at your earliest convenience. The symposium will reimburse coach-class flights along with ground transportation costs after the symposium concludes. Please email receipts to [email protected]. A room will be reserved for you at The Maybourne Beverly Hills (225 N Canon Dr., Beverly Hills, CA 90210). The course will cover up to two (2) nights room and tax. If you would like to reserve additional nights, the group rate is $415 plus taxes per evening *Enter your arrival and departure dates below along with special requests. *Requests, including early check-in, will be communicated to the hotel however cannot be guaranteed. *The hotel will require a credit card from you onsite for incidentals. *You will receive a hotel confirmation within 1 week of submission.Arrival Date(Required)Choose your hotel arrival dateTuesday, November 30, 2021Wednesday, December 1, 2021Thursday, December 2, 2021Friday, December 3, 2021Departure Date(Required)Choose your hotel departure dateThursday, December 2, 2021Friday, December 3, 2021Saturday, December 4, 2021Sunday, December 5, 2021Room Type(Required)Choose your Room Type1 Bed2 BedsRequests for the Hotel (Optional)Please note that requests will be communicated to the hotel, however cannot be guaranteed. 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 Not Applicable, I am participating in a panel and or moderating and will not present 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 Name - Signature(Required)Please enter your name again to provide your electronic signature. First Last Date of Signature(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Faculty DinnerOn behalf of the Program Directors, we are pleased to invite you and a guest to the Controversies and Advances in the Treatment of Cardiovascular Disease faculty dinner! We hope that you will join us! Please view the details and provide your RSVP below.Please note that Spago will need to check COVID vaccination cards for all diners. Thursday, December 2, 2021 Spago Beverly Hills 176 N Canon Dr Beverly Hills, CA 90210 6:45 PM – meet in the lobby of The Maybourne Beverly Hills to walk together, if desired. Spago is very close, within a block of the hotel. 7:00 PM – cocktails and hors d’oeuvres 7:30 PM – dinnerFaculty Dinner RSVP(Required) Yes, I will attend the faculty dinner myself Yes, I will attend the faculty dinner with a guest I am unable to attend the faculty dinner Promedica 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.
