Minisymposia Speaker and Co-Chair Form

Session Information

Please select your session title from the list below:*

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Please enter your session title below:

Are you a co-chair in this session?*

Yes
No

Contact Information

Has your contact information changed recently?*

Yes
No

Name

First Last

Email Address*

Alternate Email Address (or Admin Assistant email)- Optional

Institute*

Department

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name*

Emergency Contact Phone Number*

Accessibility (Americans with Disabilities Act)

The ASCB will work to ensure accessibility for people with special needs. If you require special accommodations, auxiliary aids, or services, let us know. Our meetings department will contact you to best determine your needs.

Please contact me regarding special needs under the ADA Act?*

Yes
No

Permission Releases and Electronic Signature

Photography Permission Release (You must check the box below to agree and be eligible to attend the meeting)*

Photographs will be taken at the 2019 ASCB|EMBO Meeting. By checking this box, and attending the meeting, I agree to allow the ASCB and/or EMBO to use my photo in any ASCB-related or EMBO-related publications or on the ASCB or EMBO website.

Attendance Permission Release (You must check the box below to agree and be eligible to attend)*

By checking this box, I agree to indemnify and hold harmless the ASCB and EMBO and their governing bodies, officers, directors, employees, and/or agents from all loss, damage, or liability arising out of or related to my attendance at the 2019 ASCB|EMBO Meeting. I assume all risks associated with my attendance and participation in on- and off-site activities.

Travel Reimbursement Agreement*

By checking this box, I understand that I am responsible for making my own travel arrangements and will reserve a hotel room using Experient (ASCB's Official Housing Provider) as outlined in an email from Alison Harris, ASCB Director of Meetings

Privacy Policy*

By checking this box, I have read, understand, and agree to the ASCB's Privacy Policy.

Click here to view the ASCB Privacy Policy.

Electronic Signature

In accordance with federal law, the party executing this Agreement electronically - binding the party to the same degree as a handwritten signature - by using the following process to create an electronic symbol signifying intent to be legally bound. The signer must fill in the name, institute, and date below, and check the checkbox at the end of the line marked “Electronic Signature."

The signor shall retain a paper copy of the electronic mail.

Approved and Authorized by:

Print Full Name for Signature*

Institution*

Signed Date*

Electronic Signature (Check the Box)

Presentation Preferences Information

Standard equipment available in each session includes:
- Screen
- Video/data (LCD) Projector
- Projection Operator
- MAC Computer, with mouse
- Lighted Lectern with Microphone and Confidence Monitor
- Lavalier Microphone
- Video Switcher
- Laser Pointer (in many rooms this is the mouse due to multiple screens)
- Timer
We strongly encourage presenters to bring their presentations to the Speaker Lounge in Room 22, at least an hour prior to your session. We strongly discourage presenters from using their own laptop due to compatibility issues with equipment. However, even if you plan to present from your own laptop, you need to come ot the speaker lounge so we can ensure the formatting will display correctly on our equipment during your talk or have you upload it if it will not work correctly.

I will present from my own laptop. We STRONGLY discourage this option due to issues with compatibility especially with non-U.S. laptops.*

Yes, and I understand that I may need to upload my files if my laptop is not compatible.
No

My computer preference is:*

MAC
PC

My presentation is in:*

PowerPoint
Keynote

Is there any other equipment not listed above that you will require for your presentation? Please list it in the box below and we will do our best to accommodate you.

I agree to stop by the speaker lounge at least 1 hour prior to my talk (for Symp speakers we request you stop by the afternoon prior to your talk) to ensure my presentation will display properly.*

Yes, I agree

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2019 ASCB|EMBO Minisymposia Speakers and Co-Chairs: Please fill out the form below.