Full Name *

Please Provide Your Full Name (including degrees behind your last name) as it might appear on a program/schedule, IF SELECTED.

First Name

Last Name

Type of Lecture *

What presentation format will you be submitting for? Select all that may apply to your content.

Breakout or Workshop Session

General Session

This Would Be Considered a Sponsored Presentation by a Company

Permission to Share Email With Attendees, Event Participants and Sponsors *

Do you give permission to CMT to share your email and web site address with event participants, attendees & sponsors? I agree to share the contact information I provide here (eg Full Name, Office Tel., Name of Business, Business Address, Email) with all the sponsor clients and other attendees as stated in the T&Cs for all event participants, guests and participants. If left unmarked, only your Full Name, Tel, and Address used at registration will be shared with participants and Sponsors. Thank you.

Yes. I understand and accept.

I agree not to include any copyright images in my presentation. *

In accordance with CMF/CMT "Speaker Agreement Terms and Conditions" listed here: https://conciergemedicinetoday.com/faqs, I accept all responsibility for copyright claims, damages and/or liability for future copyright claims if it has been found that my presentation included copyright images and/or material that infringed on a copyright.

Yes. I understand and accept.

Yes, I understand that is selected as a Speaker, I (and all in my party) are 100% Responsible For all Costs and Expenses. No Honorarium Will be Provided. *

This conference supports the operations of the industry trade publication throughout the year to help support this space. CMF does not provide an honorarium or reimburse speakers for travel or other expenses. Speaker is 100% responsible for all costs and expenses associated with participating in any capacity at this Conference/events. Speaker will NOT be issued a travel stipend. Speaker is responsible for all of their travel and lodging arrangements to and from the CMT event(s). CMT does not reimburse, nor cover expenses related to your travel, hotel, or any other transportation or incidental expenses incurred by the Speaker while participating in any CMT Conference.

Yes. I understand and accept.

Acceptance of Speaker and Participant T&Cs and Speaker Agreement. *

If accepted to be a Speaker on the final Schedule, by checking this box, I acknowledge that all parties listed on this application have read, understand and agree the T&Cs outlined in both the Event Participant T&Cs, AND, Speaker Agreement & Code of Conduct for this conference here: https://conciergemedicinetoday.com/faqs.

Yes. I understand and accept.

Yes, I Understand There Is No Guarantee I Will Be Chosen. *

Yes, I understand that submission is not to be considered acceptance of attendance nor participation as a Speaker. I will await written or verbal notice by a Concierge Medicine Today, LLC representative. If I have not received notice of confirmation by July 15, then I understand I was not selected. Additionally, by submitting this application, you understand that this "submission" is for consideration only. You understand that any presentation is to be relevant to Doctors and their team(s) and that any/all statements are healthcare related in their content. You understand and agree that submission is not a guarantee of selection. All Speakers understand that conference educational environments and sessions are learning experiences first, and as such, limit non-commercial content, are sales-free zones. If selected, you may be contacted by a Concierge Medicine Today, LLC (Herein "CMT") conference representative that may require and request more information in writing and/or a face-to-face zoom interview to understand your topic, content, communication and presentation skills. You represent and affirm that you have the legal right to present any content you share, and in order to do so, you agree and affirm that any content spoken, shown and/or presented it entirely is free of any conflict(s) and that the submission of such content will not violate any third party’s privacy rights, publicity rights, contract rights, copyrights, or other proprietary rights. CMT provides each Speaker with one “All-Access” Complimentary Pass to attend any and all CMF Sessions on Friday and Saturday and includes full access to the CMF exhibitor floor. Speaker/applicant understands that this conference supports the operations of the industry trade publication CMT throughout the year to help support promotion, education, public relations and awareness of this space in healthcare. Applicant/Speaker understand that CMT does not provide an honorarium or reimburse speakers for any travel or other related or unrelated expenses. Speaker is 100% responsible for all costs and expenses associated with participating in any capacity at this CMT Conference/events. Delivery of educational content is expected by all chosen and confirmed Speakers and Speaker will be notified in writing by a CMT conference/event organizer/representative. Speaker applicant understands and agrees that if they are not chosen to participate they may not be contacted and indemnify, release and hold harmless CMT, it’s affiliated companies, respective representatives, directors, officers, successors and/or agents from any and all costs and/or claims associated with not being chosen or selected to participate in a CMT Conference, activity or event, which includes any in-person or virtual activities. Speaker should refrain from overt statements, tortious interference, unlawful, immortal and unethical discussions, harsh language, discriminatory or pointed humor that disparages the rightful dignity and social equity of any individual, company or group. CMT continues to seek and provide a balanced slate of speakers with diverse backgrounds, viewpoints, and organizational affiliations. Speaker selection for a CMT conference, event or activity is at the sole discretion of CMT and its it’s affiliated companies, respective representatives, directors, officers and/or agents. Most speakers will be limited to one education session, except for repeated sessions. Speakers may also be asked or requested by a CMT representative to serve on a panel in addition to delivering the planned, one education session. Exceptions and scheduling are at CMT's sole discretion. By sharing your expertise, you make a valuable contribution to the profession's field of knowledge and to the individual education of our participants. CME will not be a requirement at this time but may be added at CMTs discretion. Speaker should also make appropriate disclosures before presenting content. Speaker/applicant understands that delivering an education session in this capacity (hosted by CMT) is done so on a voluntary, unpaid basis. Speaker's individual travel, incidental and/or living expenses are at his/her own expense. Speaker/applicant listed on this Application understands or has been informed and will be bound to these statements in addition to the CMT Speaker Agreement and agrees that submission of this "Call for CMT Speakers Application" is not a guarantee of participation, selection nor is to be considered a form or endorsement or acceptance in any fashion by CMT or any particular company or industry.

Yes. I understand and accept.