Honoraria/Speaker/Performer Checklist (U.S. citizens and permanent residents only) Is the service provider currently an MSU student, or work for MSU as a paid employee? f Instead, complete and submit the online HYPERLINK "http://mini.aacn.org/PMods/Forms/FormsTemplate.aspx?template=/WD/Forms/Docs/Chapter%20Speaker%20Request%20Form.xml&mod=Chapters&showresults=False&showAllItems=False" Speaker Request Form)
Speaker Agreement
between (name of speaker) (Speaker) and
the (full chapter name) Chapter of the American Association of Critical-Care Nurses (Chapter)
Event / Course Title:Dates:(Month/Day/Year)
Time:(list start and end times)
Location:(Name and address of facility/hotel)
Class Format:(lecture, case study, etc.) Contracted faculty are typically limited to one
EMC Speaker�s Personal Belongings:Speaker will be responsible for his/her personal belongings during the event.Lecture Materials and Printing:(Select one)
Speaker will provide Chapter with a copy of the lecture slides and materials in electronic format no later than (#) weeks preceding the seminar. The chapter should be the middleman and the supporter, the 3rd party person. H�2�3U0��t.=s#0a�gd!�R�Ҹ@��P�B����X � �b
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Following review and approval of this contract by the National office of the American Association of Critical-Care Nurses, Chapter will prepare a check for the honorarium to be paid to Speaker on site, upon completion of presentations.
The purpose of the Speaker/Honorarium process is to provide an
EMC Cancellation Clause:(All contracts must have a Cancellation Clause.) � f §
It may not be copied, sold or given away for any other purpose without expressed written permission of the Speaker. endstream
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approval/allocation may make that request directly to the Department Chair for
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The remaining balance will be paid via a chapter check, after the event and upon receipt of the Speaker�s receipts for approved expenses.
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Cancellation up to 30 days prior to class � 25% of any monies paid to or expenses paid for the Speaker will be refunded to Chapter within five�business days. Departments strongly encourage
later than the 2nd class meeting for the quarter, or as requested by
[Note: Chapter�s Nurse Planner to determine the appropriate number and category of CERPs (A, B, or C). endstream
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Chair for all guest speakers before engaging a guest speaker for
Payment. b�y4�����a�r�YJ��&��9D endstream
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Example 3: $1,000 per day; includes one copy of outline packet (paper or electronic) with learning objectives. IMPORTANT INFORMATION:Information Regarding CEs or CERPs:
If CEs will be applied for/provided to participants, then supporters should pay the chapter and the chapter then pays the supplier. endstream
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Blank sample form of honorarium letter Attach a W-8 (Certificate of Foreign Status) or W-9 (Request for Taxpayer ID) form for the speaker to complete. Payments to guest speakers are processed after services are rendered. p /Tx BMC 1.8 1.8 7.08 7.08 re H�2�3U0��t.=s#0a�gd!�R�Ҹ ���
� �����SS�xKߔFxU������h��;�#���. Example 3: All travel expenses are to be arranged by and billed directly to the Speaker. Example 2: $1,000 per day; includes one copy of outline packet (paper or electronic) with learning objectives. � endstream
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Acceptance
xxxSignature
(name), (title), (company name)Phone #Date
xxxSignature
(name), President
(full chapter name) Chapter-AACNPhone #Date
xxxSignature
(name), (title � Treasurer or Chairperson)
(full chapter name) Chapter-AACNPhone #DatePlease Note:
All Chapter Contracts must be reviewed and approved by AACN�s national office before signing. � Cancellation in last week prior to class � 100% of any monies paid to or expenses paid for the Speaker will be refunded to Chapter within five business days. Following review and approval of this contract by the National office of the American Association of Critical-Care Nurses, Chapter will prepare a check for the honorarium to be paid to Speaker on site, upon completion of presentations. If Chapter cancels the event and does not use the services of Speaker once the contract has been executed, Chapter may remain fully responsible to Speaker for the cost of any prepaid expenses such as transportation tickets, travel change fees, hotel costs or any other purchases that cannot be refunded.
https://esign.wwu.edu/admcs/forms/Provost/honorarium_speaker_approval.asp
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f the Speaker within twenty (20) days after the Engagement, provided the Speaker has complied with all terms contained herein.