Request Form

If you would like to request a meeting, please complete the fields below, enter three dates in order of priority, and submit your request. A representative from Creative Educational Concepts, Inc. (CEC) will contact you via e-mail with scheduling details.

CEC will provide the following for each activity:
- One expert chosen from our list of faculty presenters; organization and support of their logistical arrangements (honorarium and travel expenses covered by educational grant).
- One handout of the evidence-based, fair-balanced slide presentation for each attendee.
- One hour/unit accreditation for physicians, nurses, and pharmacists.
- Modest food stipend for a boxed/buffet meal to be provided during the activity, upon request.

We ask that the hospital/facility provides:
- Meeting space to accommodate the number of expected attendees.
- Audiovisual equipment such as a projector and screen for the presentation (faculty can provide their own laptop).
- If applicable, arrangements/payment for a modest buffet/boxed meal for attendees (if requesting the $300 food stipend, this is paid after the meeting once all completed paperwork is received in our office).

* 1. Please select the topic(s) you would like presented at your facility:

* 2. Contact Information

* 3. Please enter three dates/times between August 30, 2017 and July 31, 2018 in which your hospital has availability to host the one hour activity.

* 4. Meeting Room Name/Location

* 5. Anticipated # of attendees (Must have a minimum of 10):

* 7. Your presenter will need a projector and screen. Should he/she bring the presentation on a laptop, flash drive, or email in advance?