Virtual Meeting Submission Form

Is this an ISMRM or ISMRT Virtual Meeting?*

ISMRM
ISMRT

Is this virtual meeting meant for a specific group within ISMRM/ISMRT, or is it for all members?*

Specific group (study group, division, chapter, etc.)
All Members
Open to all (Fee required for Non-Members)

Which group is this meeting for?*

Event Title:*

Do you plan to produce a white paper with regard to the subject of this event?*

Yes
No

Is this program being produced in collaboration with another group within ISMRM/ISMRT?*

This includes study groups, divisions, and/or chapters.

Yes
No
No, but another group outside of ISMRM/ISMRT

Which study group/chapter/division?*

Outside Organization/Group Name:*

Who is the contact person within that group?*

Contact Person's Email:*

Contact Person's Phone:*

Preferred Date (first choice):*

Note: All events must take place on a Thursday, and all speakers and moderators must be available on the preceding Tuesday of that week for audio/video testing.

Preferred Date (second choice):*

Note: All events must take place on a Thursday, and all speakers and moderators must be available on the preceding Tuesday of that week for audio/video testing.

Preferred Time of Day

UTC = Universal Coordinated Time. Visit worldtimebuddy.com to convert your local time.

16:00 UTC – For Europe and North America time zones
17:00 UTC – For Europe and North America time zones
20:00 UTC – For Australia and North America time zones
21:00 UTC – For Australia and North America time zones
22:00 UTC – For Asia, Australia and North America time zones
23:00 UTC – For Asia, Australia and North America time zones

Overview:*

Minimum 100 words.

Other Audience Type:*

What category would this fall into?

e.g., cardiovascular, interventional, body, etc.

Select Skill Level:*

What keywords can be associated with this content?*

For search engine optimization.

Submitter's Name:*

First Last

Submitter's Member ID Number:*

Submitter's Email*

Moderator(s) Information*

All names MUST include credentials (Ph.D., M.D, RT, etc.). "Dr.", "Prof" and other salutations are not acceptable substitutes for actual credentials.
Do not leave any fields blank.
Click the (+) icon to add up to 3 more rows.

Full Name and Credentials	Email Address	Institution	City and State/Province	Country

How many presentations will be given during this meeting?*

Please note: The standard number of presentations is 2.

1 presentation
2 presentations
3 presentations
4 presentations

The standard format is a one-hour webinar with two presentations. If you wish to have an alternate format, please include details here.

IMPORTANT: All names MUST include credentials (Ph.D., M.D, RT, etc.).
"Dr.", "Prof" and other salutations are not acceptable substitutes for actual credentials.
Do not leave any fields blank.

Presentation 1 Details*

Presenter's Full Name & Credentials	Presenter's Email Address	Preliminary Talk Title	Presenter's Institution	City and State/Province	Country

Presentation 2 Details*

Presenter's Full Name & Credentials	Presenter's Email Address	Preliminary Talk Title	Presenter's Institution	City and State/Province	Country

Presentation 3 Details*

Presenter's Full Name & Credentials	Presenter's Email Address	Preliminary Talk Title	Presenter's Institution	City and State/Province	Country

Presentation 4 Details*

Presenter's Full Name & Credentials	Presenter's Email Address	Preliminary Talk Title	Presenter's Institution	City and State/Province	Country

Would you like this event accredited?*

Yes, CME
Yes, CE/CPD
Yes, both CME and CE/CPD
No

We will send you an email requesting more information to complete accreditation for CE/CPD.

Have either of these presentations previously been accredited for CE/CPD by ISMRT or another RCEEM?*

Yes
No

Please provide details on past accreditation(s).*

Please select the desirable physician attributes this event would support (select all that apply):*

Practice Gaps

Current State*

What is the current state of knowledge, skills, competence, practice, patient outcomes, etc.
What is happening?
Click the (+) icon to add more rows. Give at least three answers.

E.g. "Practitioners… are not using/cause problems when/have been shown to be unaware/still perform x instead of y in n% of cases…"

Desired/Ideal State*

What is the desired/ideal state?
What is achievable?
Click the (+) icon to add more rows. Give at least three answers.

E.g. We have the ability to/ we can…

References & Supporting Documents*

What sources were used to identify the gap(s) for this activity? Please include at least one.
Ex.: Planning Committee Meeting Notes or Minutes, Clinical Practice Guidelines, Literature Search, Peer-reviewed scientific/clinical publications, etc.

Click the (+) icon to add more rows.

Needs*

What knowledge, skills or abilities are necessary to improve/overcome the problem?
Click the (+) icon to add more rows.

Target Audience:*

Technologists/Radiographers
Physicians/M.D.’s
Scientists/Researchers
Other

How would the above target audience benefit from this event?*

How will the information be communicated or distributed to the audience, and what are the benefits of this approach?*

Formats that reflect Adult Learning Principles: Case-based, or in other ways linking what you are learning to real practice|Lots of time for learner interaction – with the teacher and other colleagues |Opportunities to think about or review what you are doing in practice, how you might improve, and support for making changes

Objectives for Attendees*

• Include a minimum of three objectives.
• Tip: Begin each objective with a quantifiable action verb such as "identify," "recognize," "explain," and "support." Look at the objectives from past events for examples.
• To add more objectives, click the (+) icon on the right to add more rows.

Upon completion of this course, attendees should be able to...

Objective 1	Objective 2	Objective 3

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