34th Annual Cardiovascular Interventions November 7-10, 2023Hilton La Jolla Torrey Pines, La Jolla, 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 Scripps 34th Annual Cardiovascular Interventions 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 Hotel ReservationIf desired, a room will be reserved for you at the Hilton La Jolla Torrey Pines. The course will cover up to 4 nights room and tax. *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 1-2 weeks of submission.of this formRoom Reservation(Required) Yes, I will need a hotel room reserved for me No, I will not need a hotel room reserved for me Arrival Date(Required)Choose your hotel arrival dateMonday, November 6, 2023Tuesday, November 7, 2023Wednesday, November 8, 2023Thursday, November 9, 2023Friday, November 10, 2023Departure Date(Required)Choose your hotel departure dateTuesday, November 7, 2023Wednesday, November 8, 2023Thursday, November 9, 2023Friday, November 10, 2023Saturday, November 11, 2023Sunday, November 12, 2023Room 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 34th Annual Cardiovascular Interventions symposium will provide an online syllabus for attendees. The online syllabus will include all relevant meeting materials as well as the faculty slides presented in the CME portions of the course, in PDF format, when approved by the speaker. Attendees will be able to access the information for approximately one year after the symposium concludes.Permission for a PDF of your slides to be shared with attendees in the 2023 online syllabus(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 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 34th Annual Cardiovascular Interventions 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)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Faculty DinnerOn behalf of the program directors, we are pleased to invite you to attend the 34th Annual Cardiovascular Interventions faculty dinner! Thursday, November 9, 2023 Manhattan of La Jolla (Inside the Empress Hotel) 7766 Fay Ave La Jolla, CA 92037 7:00 PM Cocktails followed by dinner If you need transportation to the restaurant, please arrange for an Uber, Lyft, or taxi and include these receipts in your expense reimbursement after the course concludes. Complimentary valet service will be provided for those that drive to dinner. Faculty 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 34th Annual Cardiovascular Interventions symposium! You will receive a copy of this form for your records via email within 3 business days. Please click "Submit" below to finalize. CURRENT AGENDA
