ACRP Chapter Event Request Form

Today's Date*

Chapter Name*

Submitter's Name*

Submitter's Email Address*

Event Point of Contact for Attendees (Name & Email Address)

Event Title*

Date of Event*

Is this a multiple day event?*

Yes
No

If yes, please give full date range and time details here:*

Start Time*

:

End Time*

:

Time Zone*

Type of Event*

Virtual Event
In-person Event
Hybrid Event

Event Location*

Event Category (Select all that apply)*

Networking/Social
Educational

What type of educational content will be shared at the event?*

ACRP Generated Content (Online Conference Library or Webinar Replay)
External Content
Other

Please describe the type of educational content that will be shared.

Number of contact hours requested*

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Policy: ACRP Chapter Education Events (External Content) Offering Continuing Education Credits*

In alignment with policy approved by the ACRP Board of Trustees, ACRP no longer provides pre-approval of ACRP Contact Hours for third-party educational content, inclusive of educational content developed by and/or through ACRP Chapters.

To provide attendees with pre-approved ACRP Contact Hours, ACRP Chapters are encouraged to leverage ACRP’s robust catalog of foundational training and continuing education programs available for use by ACRP Chapters and pre-approved for ACRP Contact Hours.

ACRP Chapters who wish to develop educational programming, including live events, may continue to do so, and attendees/learners may self-report those activities for use toward ACRP Maintenance of Certification, subject to review and acceptance by the Academy of Clinical Research Professionals in accordance with criteria established in the ACRP Maintenance of Certification Handbook.

I have read the above policy related to delivering external educational content at my Chapter event.

How many hours of educational content will be presented at this event?*

Event Learning Objectives*

Please include at least three objectives

Name of Speaker(s)*

If multiple speakers, list all speakers separated by commas

Event Description*

Event Agenda*

Event Registration Information

Registration Close Date*

Maximum Capacity for Registration (if applicable)

Chapter Member Registration Fee (this is inclusive of ALL chapter members)*

ACRP Member (no chapter) Registration Fee*

Non-Member Registration Fee*

Additional Event Registration Information/Comments

If you would like to add additional price points or registration categories, please list them here.

Additional Event Information/Comments

Accompanying Materials

Feel free to upload any accompanying materials for your event (flyers, photos, graphics, etc.).

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.

Email

This field is for validation purposes and should be left unchanged.