DMEC WEBINAR SUBMISSION FORM

A representative of the webinar sponsor is required to complete the submission form below. Please complete this form 90 days prior to the scheduled event. This allows DMEC the time needed to apply for CEUs and conduct webinar promotion. You may request updates to your DMEC webinar event details page up to seven (7) business days prior to the live event.

"*" indicates required fields

Name*

First Name Last Name

Company*

Job Title*

Phone*

Email*

Webinar Details

Date*

Title of Webinar*

This title will be used to market your webinar. Please limit your title to 60 characters or less.

Webinar Description (brief paragraph describing your webinar)*

Optional Resource URL Link: The resource link must be pertinent to the event topic and supplement the information provided in the webinar (i.e., toolkit, white paper, or other educational information).

Learning Objectives

Objective #1:*

Objective #2:*

Objective #3:*

Objective #4:

Primary Presenter:

Primary Presenter Name

First Name Last Name

Primary Presenter Professional Designations

Primary Presenter Job Title

Primary Presenter Company/Organization

Primary Presenter Email

Primary Presenter Phone

Primary Presenter Mailing Address

Headshot Submission Guidelines:

Accepted file types: jpg, jpeg, png, gif.

Presenter headshots will be featured on the DMEC website and used for promotional purposes. Headshots should be professionally sourced with a plain background, at least 400 pixels wide, and be in jpg or png format. Photos with outdoor or busy backgrounds, cropped photos, and photos that don’t portray a professional or business image will not be used.

Primary Presenter Biography

Do you have a second presenter?

Yes

Second Presenter Name

First Name Last Name

Second Presenter Professional Designations

Second Presenter Job Title

Second Presenter Company/Organization

Second Presenter Email

Second Presenter Phone

Second Presenter Mailing Address

Headshot Submission Guidelines:

Accepted file types: jpg, jpeg, png, gif.

Second Presenter Biography

Do you have a third presenter?

Yes

Third Presenter Name

First Name Last Name

Third Presenter Professional Designations

Third Presenter Job Title

Third Presenter Company/Organization

Third Presenter Email

Third Presenter Phone

Third Presenter Mailing Address

Headshot Submission Guidelines:

Accepted file types: jpg, jpeg, png, gif.

Third Presenter Biography

Need assistance completing this event form? Contact Paul Stetler at pstetler@dmec.org or 800.789.3632, ext. 133.

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