Webinar Information Form

Once you’ve completed the payment form, if necessary, in the Webinar Prospectus, please gather the information below. To fully complete this online form, you will need to complete three (3) sections, the Presenter Section, the Webinar Section, and the PACE section. You may complete one section at a time or all at once, but all questions are required in each section, so please do not proceed until you have ALL of the information required for the section you wish to complete. Below you will find a list of information required in each section to help you prepare to complete the form.

If you have any questions about any of the information required in this form, please consult the Webinar Prospectus. If that doesn’t answer your question, as Executive Director Linden Mueller or Education Chair Jill Dunnam.

When you’re ready to complete the form, scroll to the bottom of the page and click the “Complete Form Now” link.


  • Company name (to coordinate information in sections)
  • Your name, in case we need to contact you later
  • Your email address, in case we need to contact you later


  • Presenter name
  • Presenter email
  • Presenter phone, direct line if available
  • Presenter head shot, image file upload to Google Drive, Google login required
  • Presenter bio


  • Webinar title
  • Webinar description
  • Webinar learning objectives, four (4) are required


The instructor MUST complete this section him- or herself.

  • Instructor conflict of interest declaration
  • Instructor affidavit of image authenticity