Your 5-Digit Member Number*

Your Name*

First Last

Your Email*

Which division is this proposed meeting for?*

Proposed division meeting title:*

Organizing Committee*

Click the (+) icon to add more rows.

First Name	Last Name	Email	Institution

Proposed Date Options:
Each date must be unique.

1st Date Choice*

2nd Date Choice*

3rd Date Choice*

Which day of the week would you prefer for your meeting?*

No Preference
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Proposed Location*

Leave "State" blank if not applicable.

Venue	City	State (if applicable)	Country

Which type of Division Meeting?*

Local Meeting (up to two hours max)
Division Meeting with Standard Meeting Services Package (two-hour meeting minimum)
Division Meeting with Premium Meeting Services Package (four-hour meeting minimum)

Division Meeting - Local

SMRT Affiliated Meeting. Education session between 30 minutes to 2-hours max. The speakers will be in coordination with the Division Representative. A toolkit will be available for local meeting (event slides, brochure template, and certificate of participation template). There is no SMRT Central Office administration required and there will be no meeting fee. The event will be placed on the SMRT Divisions Meeting Calendar and available on the SMRT National Chapters & Division website. These sessions will not provide CE Education Credits.

Local Meeting type:*

Face to Face Meeting: Local Speakers
Face to Face Meeting plus eLearning: Local Speaker(s) and one to two presentations from SMRT eLearning website
Virtual Meeting: Two to three speakers (max) and one moderator

Speaker(s)*

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First Name	Last Name	Institution	Primary Email	Primary Phone

Moderator*

First Name	Last Name	Institution	Primary Email	Primary Phone

SMRT eLearning Center Videos*

List the presentation titles here.
Click the (+) icon to add one additional row.

Division Meeting - Standard Meeting Services Package

Base Rate is US$800.00 + US$45.00 per additional 1.0 CE credit / CPD hours in excess of 4.0 CE Credits/CPD hours.

SMRT Affiliated and Accredited (up to 4.0 credits, over 4.0 credits will be at an additional cost). This meeting will have approximately 25 attendees. This education session will be at least 2-hours. Speaker information and the required speaker documentation will be coordinated with the SMRT Central Office and Division Representative. All Speaker materials and registration information (member/nonmember rates) must be received at least 30 days prior to the meeting date. Registration for the event will be through the SMRT Central Office. Online Meeting evaluation will be available to the attendees after the event to complete for and CE/CPD certificates.

Organizers will receive a toolkit from SMRT Central Office including:

Event Slides
Brochure Template
Speaker Declaration PowerPoint Slide
CE/CPD Certificate of Credit and/or Certificate of Participation Template

Each Speaker will be required to submit the following information at least 30 days prior to the event:

CV/Resume
Objectives
Speaker Financial Disclosure form (Speaker(s) & Moderator)

Speaker(s)*

Click the (+) icon to add additional rows.

First Name	Last Name	Institution	Primary Email	Primary Phone

Moderator*

First Name	Last Name	Institution	Primary Email	Primary Phone

Division Meeting - Premium Meeting Services Package

Base Rate is US$1800.00 + US$45.00 per additional 1.0 CE credit / CPD hours in excess of 4.0 CE Credits/CPD hours.

SMRT Affiliated and Accredited (up to 8.0 credits, over 8.0 credits will be at an additional cost). This meeting will have approximately 25 attendees. This education session will be a minimum of 4-hours. Speaker information and the required speaker documentation will be coordinated with the SMRT Central Office and Division Representative. All Speaker materials and registration information (member/nonmember rates) must be received at least 30 days prior to the meeting date. Registration for the event will be through the SMRT Central Office. Online Meeting evaluation will be available to the attendees after the event to complete for and CE/CPD certificates.

Organizers will receive a toolkit from SMRT Central Office including:

Event Slides
Brochure Template
CE/CPD Certificate of Credit and/or Certificate of Participation Template
Speaker Declaration PowerPoint Slide
Meeting-Specific Web Page
Marketing bundle (event email notifications to SMRT members, website page and social media postings)

Each Speaker will be required to submit the following information at least 30 days prior to the event:

CV/Resume
Objectives
Speaker Financial Disclosure form (Speaker(s) & Moderator)

Speaker(s)*

Click the (+) icon to add additional rows.

First Name	Last Name	Institution	Primary Email	Primary Phone

Moderator*

First Name	Last Name	Institution	Primary Email	Primary Phone

SMRT Division Meeting Proposal Form

SMRT Division Meeting Proposal Form

Division Meeting - Local

Division Meeting - Standard Meeting Services Package

Division Meeting - Premium Meeting Services Package