Community of Interest Webinar Request Form

Submit Your Webinar Request

Select the Sponsoring COI(Required)

Point of Contact (POC) Please include the name and email(Required)

POC Email(Required)

Originator (if different from the POC) Please include the name and email

Please enter the date & time (including time zone) for your webinar(Required)

Please enter the date & time (including time zone) for your Dry Run (practice, communication check, etc.) session(Required)

The Dry Run date/time may have to be adjusted in the case of an unavoidable conflict. If a conflict arises, the Staff Liaison will coordinate an acceptable date/time with the Point of Contact.

Webinar Title (10 words or less)(Required)

Webinar Description (200 words or less)(Required)

Speaker, Full Name (Include rank and suffixes, if applicable)(Required)

First Last Suffix

Speaker 1, Job Title/Position(Required)

Speaker 1 Bio

Speaker 1 Photo (if you do not have photos for all speakers, we will not publish photos)

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

Speaker 1 Organization(Required)

Speaker 1 E-mail:(Required)

Speaker 2 Full Name

First Last

Speaker 2 Title

Speaker 2 Bio

Speaker 2 Photo

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

Speaker 2 Organization(Required)

Speaker 2 Email(Required)

Speaker 3 Full Name

First Last

Speaker 3 Title

Speaker 3 Bio

Speaker 3 Photo

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

Speaker 3 Organization(Required)

Speaker 3 Email(Required)

Moderator, Full Name (Include rank and suffixes, if applicable)(Required)

First Last

Moderator Job Title/Position(Required)

Moderator Bio

Moderator Photo

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

Moderator Organization(Required)

Moderator Email(Required)

Request COI notification email blast?

Yes

If yes, which COI(s) should be notified?

Text of requested email blast:

PDH Offered

Yes

PDH Form

Upload Form

Max. file size: 20 MB.

Learning Objectives (3-5 required for PDH, 4 required for AIA

Is there anything else beyond this form that we should know about your webinar?

Yes

If the answer to the above question is yes. Tell us more about your webinar

Upload webinar feature image (original size only)(Required)

Accepted file types: jpg, png, Max. file size: 20 MB.

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