CMSA S Ambassador Program Is Designed to Provide National Outreach to the Local Chapters

CMSA’s Ambassador Program is designed to provide national outreach to the local chapters. Not only does national bring an educational program to the members, but allows interaction and discussions with board members, and messaging to both members and non-members about what CMSA is doing for the association and the industry.

SPEAKER REQUEST

All chapters are welcome to submit a request to have a national speaker attend your meeting! Pleasecomplete the form below, then save and email. You will be contacted for any additional questions, and receive more information on descriptions, objectives, speaker bio, etc.. to help promote your event.

CHAPTER INFORMATION

Chapter Name:
Contact Name: / Contact Title:
Contact Phone: / Contact Email:

Best way to contact you: Phone EmailBest Time to Contact You:

PROGRAM REQUESTED

The Opioid Crisis (1 hr.)

The Opioid CrisisContinues (2 hr.)

Ethics for the Case Manager (1hr.)

Case Management Ethics: Lifting the Fog (2 hrs) – This program alsooffers CCM Ethics hours.

Communication, Case Management and Care Coordination for the COPD Patient (2 hrs)

The above programs have been pre-approved for CCM, SW, and RN hours.

MEETING INFORMATION

Date: / Time(s):
Meeting Facility: / Estimated Attendance:
Meeting Address: / Meeting Sponsor:

Is this a regular monthly educational meeting? Yes No

If NO, what type of event is this?

NOTE: Management of CE’s becomes more complicated when other programs are occurring like within a conference or workshop. If you are needing to file for your own CE’s within your full program, please let us know. We can provide the content needed to add to your CE applications.

Yes, we need to file our own CE’s for the full program. No, this is a stand-alone program and will use CMSA pre-approved CE’s.

TRAVEL INFORMATION

Please share the following information to best support the speaker in setting up their travel.

Closest Airport:
Closest Hotel to the Meeting: / Hotel Phone #:
Other Travel Information:

TRAVEL REIMBURSEMENT

The speakers do not require honorariums, but do seek reimbursement for travel. This may include airline, hotel, travel to and from airport, and a possible meal.

The chapter understands and accepts the responsibility of reimbursing speaker for travel expenses.

The chapter has limited funds and like to seek support to pay travel expenses.

Please share the reason chapter needs financial support: