Skip to content
Search:
Search
CONNECT COMMUNITY
CE ORGANIZER
LABUCATE VIRTUAL LEARNING
MEMBER CENTRAL
Resources
Facebook page opens in new window
Twitter page opens in new window
Instagram page opens in new window
Linkedin page opens in new window
YouTube page opens in new window
ASCLS
The American Society for Clinical Laboratory Science
Membership
Benefits
State Society Groups
Join
Renew
Membership Packages
Education
Annual Meeting
Registration
Accommodations
Poster Abstract Submissions
CLEC
Registration
Poster Information
Accommodations
Partner Engagement
eCLECtic Blog
Webcasts-Webinars
Webinars
Educator Resources
Laboratory Educators Institute
Manager Resources
ELMC2
CE Organizer Data Transfer
Labucate Virtual Learning
Online P.A.C.E. Courses
Legislative Symposium
Communication
Social Media
Society News Now
ASCLS Today
Podcasts
ASCLS Connect Community
eNewsBytes
Clinical Laboratory Science Journal
The Bench Connection
Participate
Forums
Ascending Professionals Forum
Developing Professionals Forum
Diversity Advocacy Council
PRISM
House of Delegates
States
Committees
Governance Resources
Volunteer Opportunities
Scientific Assemblies
Lab Week-MLPW
Leadership Academy
Mentorship Program
Advocacy-Issues
Legislative Symposium
Licensure
Workforce
ASCLS Political Action Committee
Patient Safety
Labvocate Action Center
Position Papers
Careers
Career Center
Career Center – Job Search
Career Center – Employers
How do I become a laboratory professional?
Online Academic Programs
Certification Information
DCLS
Career Recruitment Tool Kit
Laboratory Science Careers Website
P.A.C.E.
PACE Home
PACE Providers List
Online P.A.C.E. Courses
About Us
Mission Vision Statement
Code of Ethics
Board of Directors
Leadership
Leadership Directories
Leadership Resources
House of Delegates
Past Presidents
Staff
Awards and Scholarships
Education and Research
History
Industry Support
ASCLS Voices Under 40
Calendar
Membership
Benefits
State Society Groups
Join
Renew
Membership Packages
Education
Annual Meeting
Registration
Accommodations
Poster Abstract Submissions
CLEC
Registration
Poster Information
Accommodations
Partner Engagement
eCLECtic Blog
Webcasts-Webinars
Webinars
Educator Resources
Laboratory Educators Institute
Manager Resources
ELMC2
CE Organizer Data Transfer
Labucate Virtual Learning
Online P.A.C.E. Courses
Legislative Symposium
Communication
Social Media
Society News Now
ASCLS Today
Podcasts
ASCLS Connect Community
eNewsBytes
Clinical Laboratory Science Journal
The Bench Connection
Participate
Forums
Ascending Professionals Forum
Developing Professionals Forum
Diversity Advocacy Council
PRISM
House of Delegates
States
Committees
Governance Resources
Volunteer Opportunities
Scientific Assemblies
Lab Week-MLPW
Leadership Academy
Mentorship Program
Advocacy-Issues
Legislative Symposium
Licensure
Workforce
ASCLS Political Action Committee
Patient Safety
Labvocate Action Center
Position Papers
Careers
Career Center
Career Center – Job Search
Career Center – Employers
How do I become a laboratory professional?
Online Academic Programs
Certification Information
DCLS
Career Recruitment Tool Kit
Laboratory Science Careers Website
P.A.C.E.
PACE Home
PACE Providers List
Online P.A.C.E. Courses
About Us
Mission Vision Statement
Code of Ethics
Board of Directors
Leadership
Leadership Directories
Leadership Resources
House of Delegates
Past Presidents
Staff
Awards and Scholarships
Education and Research
History
Industry Support
ASCLS Voices Under 40
Calendar
ELMC2 Presenter Agreement
You are here:
Home
ELMC2 Presenter Agreement
Instructions
You must complete all REQUIRED fields and hit the SUBMIT button (at the bottom of this page) in order for your information to be captured. Upon successful submission, you will receive a confirmation email.
Name
*
First
Last
Credentials
*
Limit to highest advanced degree earned and one certification of your choice. Board of Certification (BOC) credentials must be consistent with BOC guidelines - www.ascp.org/boc.
Affiliation/Workplace
*
List your professional affiliation as you would like it to appear in the program (Note: only one institution or company name will be listed in the program.) Please only list your institution; do not include your title.
Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Email
*
Mobile Phone
*
Title of Presentation
*
Presentation Description
*
Used in promoting presentation; please limit to 2 - 3 sentences.
Level of Instruction
*
This assists the potential attendee determine if the program will be suitable for their level of experience with the subject. *Basic: Entry level; no prior knowledge of subject necessary *Intermediate: Refresher course; some basic knowledge required; for the experienced staff technologist with some years of experience *Advanced: Highly technical; for those with current skills/knowledge and extensive experience in a specialty area
Advanced
Intermediate
Basic
Presenter Introduction
*
Please provide pertinent information that relates to this session/topic. This background information will be used to introduce you at the beginning of your presentation. Please limit biographical information to 50 words or less.
Presenter Headshot
This image will be uploaded to our event app and associated with your speaker profile. Some images will be used on our website to highlight sessions.
Max. file size: 360 MB.
Learning Objectives
Provide 3 different learning objectives for your presentation by completing this sentence: “At the conclusion of my presentation, participants will be able to….” Learning objectives must be measurable, so please begin with words like “Identify”, “classify”, “summarize”, etc. Please refrain from beginning objectives with the verbs "understand," "learn" or "know."
Learning Objective 1
*
Learning Objective 2
*
Learning Objective 3
*
Disclosure of Conflicts
*
The possibility for bias or a conflict of interest occurs when the financial interests of a speaker/author potentially preclude an unbiased, scientific presentation of a subject. The disclosure of possible conflict of interest is requested not to censor or exclude speakers, but to inform the audience so they may decide for themselves whether or not a presentation is biased. Information from this declaration will be disclosed to participants as follows: “Dr. Smith has research support from ABC Technology, Inc.” but will not be used to exclude speakers from an activity. ASCLS requires all speakers in accredited Continuing Education Activities to disclose any possible bias or conflict of interest regarding the topic that is being presented. A conflict of interest is defined as any financial interest of the speaker in a company's products or services discussed in the presentation. For example, if the speaker (1) directly holds stock in the company (not including mutual funds), (2) is paid salary or consultant fees by the company, (3) has grant support from the company, and/or (4) has received support for travel expenses, honoraria, etc., from the company, a conflict of interest exists regarding this topic and must be reported. If the speaker has a financial interest in a company but is not discussing a product or service of that company, no conflict of interest must be disclosed. Please select the appropriate statement below as it relates to the topic of your presentation within the preceding 12 months:
I do not have any financial interests that would present a potential conflict of interest with the presentation of this session.
I have a financial interest that would present a potential conflict of interest.
Please provide any information on stocks, Consultant Fees, Grants/Research or Honorariums/Expenses.
*
By submitting this form, you are agreeing that you understand and accept the terms of your participation as stated in this agreement, financial disclosure and the Presenter Guidelines & Information.
Go to Top