Faculty Tasks: Medical Director and Clinician Leadership Forum 2023

We are pleased to include you as a presenter at Optum Health Education’s Medical Director and Clinician Leadership Forum, to be held April 26, 2023, at the Park MGM Las Vegas

Please review and complete the tasks below for your participation:

You may upload the file(s) under the listed tasks below or email them to Bethany.severson@optumhealtheducation.com. Note: PPT presentation files are typically too large to email.

Complete and return the Faculty Disclosure Form as soon as possible, or by March 17.
- Click here to download the Faculty Disclosure Form. Do not complete the form in a browser window, download a copy to enable all fields for completion.
Provide a brief narrative bio by March 17.
Complete and return the Faculty Agreement and Honorarium Contract by March 17.
Finalize travel details by March 17.
Upload a copy of your PowerPoint presentation for accreditation review by April 3.

Attachment	Size
Faculty Disclosure Form \| REQUIRED	331.81 KB
Blank W9 \| REQUIRED for Honorarium	140.24 KB
Faculty Presentation Guidelines	146.88 KB
Optum Health Education PPT Template (Optional)	4.49 MB
Expense Reimbursement Form	647.43 KB

Presenter Information | Due March 17, 2023:

Please provide these materials by March 17. Files may be uploaded here or may also be emailed to Bethany.severson@optumhealtheducation.com
> Faculty Disclosure Form. (required for accreditation)
> A brief narrative bio. (required for accreditation)
> Completed Faculty Agreement and Honorarium Contract
> W9 for Honorarium Check

Presenter First Name *

Presenter Last Name *

Presenter Email *

Alternate Contact Person

Such as an administrative assistant, or alternate person, you would like included in ongoing communication about your participation at this conference.

Alternate Email

Presenter Cell Phone

Please provide a cell phone number we can use the day of the activity in case of emergency.

Completed Disclosure Form

Files must be less than 2 MB.
Allowed file types: txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

Provide a brief narrative biography.

Files must be less than 2 MB.
Allowed file types: txt rtf html pdf doc docx odt odp xls xlsx ods xml.

Twitter handle

Completed Faculty Agreement and Honorarium Contract

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

W9 for Honorarium Check

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

Presenter Image/Headshot

We will try to source an image from your organization's website. You may provide an alternate image if preferred.
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

Travel Arrangements | Due March 17 2022:

Air Travel Information

We request airfare is booked at least 6 weeks prior to departure date. Flights may be booked by Optum Health Education's travel coordinator. If you prefer to book airfare on your own for reimbursement you are free to do so. Upon booking, please email a copy of your itinerary to Bethany.severson@optumhealtheducation.com to use as a receipt. Standard coach class is reimbursable.

I would like to have Optum Health Education's travel coordinator assist in booking my airfare.

I will book airfare on my own for reimbursement.

I do not require air travel for my participation.

Hotel Reservation Request

Optum Health Education will arrange presenter hotel accommodations. One to two nights will be covered by our department. If you wish to extend your stay we can make the reservation accordingly and the additional nights will be charged to you. Conference Lodging: NoMad Las Vegas, 3772 S Las Vegas Blvd., Las Vegas, NV 89109 Website: https://nomadlasvegas.mgmresorts.com/en.html

Yes, I will require a hotel reservation for my participation.

No, I will not require a hotel reservation for my participation.

Check-In Date:

If you don't know your check-in date at this time you may skip this option and email Bethany.severson@optumhealtheducation.com when the date is known.

Check-In Date: Other preferred date

Check-Out Date:

If you don't know your check-out date at this time you may skip this option and email Bethany.severson@optumhealtheducation.com when the date is known.

Check-Out Date: Other preferred date

Comments or Questions for Optum Health Education

Presentation Copy| Due April 3, 2023:

Upload your PowerPoint presentation for accreditation review.
NOTE: The best format is 16:9 for wide screen projectors. Please prepare your slides using 16:9 formatting if possible.

Alternate secure upload site for files without file size limitations:
Website: https://oheln.basecamphq.com/projects/15082923-conference-presentation/files
Username: moreinfo@optumhealtheducation.com
Password: OHE2013

Live polling is available through our conference mobile app. Please indicate if you are interested in utilizing live polling.

Yes, please contact me with information on live polling.

No, I do not plan to use live polling.

Optum Health Education may post a PDF copy of my presentation on the attendee conference mobile app.

Yes

Optum Health Education will provide a dedicated MAC computer onsite. Will you require additional audio visual capabilities, such as playing video clips or using an alternate laptop?

No additional AV setup

Yes, additional AV setup needed

Optum Health Education will provide a dedicated MAC computer onsite. Will you require additional audio visual capabilities, such as playing video clips or using an alternate laptop? Yes, additional AV setup needed

Presentation File

If your file is too large to upload, we have an alternate secure upload site for files.
Files must be less than 2 MB.
Allowed file types: pdf ppt pptx.

Faculty Travel Expenses | Due May 26, 2023:

Expense Form

Upload or email your expense reimbursement request to bethany.severson@optumhealtheducation.com
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx odt ppt pptx odp xls xlsx ods xml.

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