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Association of Surgical Technologists>

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SPEAKER APPLICATION
AST EDUCATORS/NATIONAL CONFERENCES

On behalf of AST, thank you for your interest and commitment to contribute to the learning experience of our conference attendees as they strive to maintain and develop their professional growth in knowledge development.

To apply to be a speaker at an AST event, please make sure to complete the entire application before submitting. Incomplete applications will not be reviewed. Once your application has been submitted, a review team will validate qualifications and determine the need, topic appropriateness and session availability. If approved to speak, you will usually be contacted within 14 days of initial submission with more information and to request additional documentation as necessary.

Please note that if the AST has personally extended an invitation for you to speak at an event, you will still need to complete an application. However, you are automatically approved by the review panel, pending validation of qualifications.

Our publication department relies on having accurate and timely information submitted to meet their publications schedules. If approved to present at an event, in order to ensure a smooth process for all parties involved, please be sure to turn in all requested documentation by their deadline.

The following qualifications MUST be met to be approved to present at an AST live event or webinar:

  • Any CST or CSFA must:
    • Be an active member and in good standing with AST.
    • Be registered for the event in which you are assigned to speak.
    • Be currently certified through the NBSTSA.
    • Be knowledgeable of the subject you are presenting

Please feel free to contact us should you have additional questions at [email protected]



Please read and acknowledge the following statements before proceeding with the application:



Check each one






BIOGRAPHIC DATA

PERSONAL


Preferred

Preferred

Preferred


WORK





Preferred

Preferred

QUALIFICATIONS

Were you recommended to speak?
If so, who recommended you?

Educator's only

My campus is CAAHEP accredited:
Please attach a copy of your resume or curriculum vitae that includes education that has been completed. (If approved, this information may also be used to create your speaker introduction).





Allowed file types: .jpg, .png, .doc, .docx, ppt, pptx 10MB each max.

Please attach a recent photo of yourself. (Professional headshots only). *Optional (you will be asked to provide this if approved)

AST PRESENTATION TOPIC

* To be considered, you must include a topic and at least three objectives.

* A brief summary must be included.

* Each co-presenter must complete a separate application.




AST SPEAKER AUDIOVISUAL

Each meeting will be equipped with the following items: laptop, podium with microphone, LCD projector and screen.

If you prefer to use your personal Mac computer, please bring the video dongle or we will be unable to open your presentation.

AST SPEAKER RELEASE

I acknowledge that the Association of Surgical Technologists may utilize various media to produce lectures, panel discussions and handout materials presented at the National Conference. This may include presentations given by me and panel discussions in which I participate. I further acknowledge that such compilations of these materials may be sold or provided free of charge by AST, their agents, and representatives to registered attendees and other individuals.


AST DISCLOSURE OF FINANCIAL RELATIONSHIPS

In order to comply with relevant continuing education standards the AST disclosure is to ensure that a speaker who is in the position of being able to control the content of the educational activity has disclosed to AST all relevant financial relationships with any commercial interest (see definitions below). Upon review, if it is decided that a conflict of interest is present due to a financial relationship you, spouse or partner may have, you will be contacted to discuss methods to resolve the conflict. Additionally, all disclosures must be revealed by a slide at the beginning of the educational activity. Failure or refusal to disclose the conflict(s) could be reason for withdrawing the invitation to speak at the AST event.

As a sponsor of continuing education for the Certified Surgical Technologist (CST) and Certified Surgical First Assistant (CSFA), AST must ensure objectivity and balance in all the continuing education (CE) activities.

Presentations must provide a balanced view of therapeutic options. If your presentation includes the use of a drug(s), the generic name of the drug must be used. Additionally, if the presentation describes the use of a drug, medical device or product that is not FDA approved or the unapproved use of a drug, medical device or product, the speaker has the responsibility for disclosing this information to the audience during the presentation.

The intent of this disclosure is not to prevent speakers/subject matter experts with a significant financial relationship from making a presentation, but rather to provide the audience with information for their own judgment.

AST CONFLICT OF INTEREST

This information will be published in AST conference materials to ensure an informed audience, unless notified in writing otherwise.

If a speaker has an identified conflict, AST’s continuing education department may contact the speaker to resolve any issues prior to the presentation.



Please type your name as your signature:



Glossary

Commercial Interest: Any proprietary entity producing, marketing, reselling or distributing health care goods or services consumed by, or used on, patients. Health care providers of clinical services directly to patients are not considered to be commercial interests.

Conflict of Interest: Individual is involved in one or more financial interests that could possibly be used to affect the content of the presentation as related to commercial medical products or services.

Financial relationships: Relationship(s) in which the individual benefits by receiving consulting fees, fee(s) for membership on a board, fee(s) for membership on an advisory or review committee, honoraria, intellectual property rights, royalty, salary, speaker fees (speaker’s bureau), stocks or stock options, and/or travel benefits. AST includes the financial relationships of a partner or spouse.