Chapter Event Support Form

Required Information

Today's Date*

Chapter Name*

Submitter's Name*

Submitter's 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*

Event Description*

Type of Event*

Virtual Event/Webinar with live speaker
In-Person Conference or Session
ACRP-Generated Content (Online Conference Library or Webinar Replay)
Event not requiring contact hours (networking event, certification prep course., etc.)

Do you want ACRP to provide registration support?*

Yes
No

Additional Information/Comments

Section I - Request for Educational Content Approval for Contact Hours

Please include all contact hour information for this event as requested. If an original speaker, the content will be reviewed for approval; ACRP-generated content does not need approval.

Number of contact hours requested

Event Learning Objectives

Please include at least three objectives

Event Agenda

Program Details, MUST include slides and/or program flow/abstract

Detail program as much as possible, more information may be requested if uploads provided are insufficient.

Drop files here or

Max. file size: 75 MB, Max. files: 2.

Name of Speaker(s)

If multiple speakers, list all speakers separated by commas

Speaker's Biography and/or Link to LinkedIn Profile

If multiple speakers, please include biographies for all speakers

ACRP Contact Hour Activity Agreement*

Please review the statement below which must be agreed to by the chapter for your content to be approved. By agreeing to this statement, the chapter acknowledges that they will ensure that all speakers abide by these requirements and work with speakers if changes to presentations are needed.

The Association of Clinical Research Professionals (ACRP) is committed to providing professional development that maintains a professional standard of those engaged in clinical research. The purposes of the Continuing Competency requirements established by the Academy are that credential holders continue to; master new clinical research-related skills and techniques; enhance approaches to effective clinical research, both within their specified job role and beyond; further develop professional judgement; conduct clinical research in a safe and ethical manner.

As part of this commitment, ACRP requests that content is educational in nature and aligned with the ACRP Core Competencies, Detailed Content Outline (DCO) of the ACRP certification exams, and/or Hot Topics in the clinical research industry. The content should cover transferable knowledge and skills, not those specific to the workplace, such as company SOPs, protocols, or specific software.

Clinical Research product or service promotion of any type is prohibited. Company names, logos, websites, etc. cannot be inserted into the body of the presentation. They can be provided on the first or last slide of the presentation.

I confirm that the content of this event meets the requirements set by ACRP.

Section II - Request for ACRP Contact Hour Management

By using our system for contact hour management, we provide a link for contact hour registration that you share with attendees. Attendees complete an evaluation form after the event which will generate a contact hour certificate automatically uploaded to the attendee’s ACRP profile.

Do you want to use ACRP’s system for providing contact hours to event attendees?

While the use of our contact hour management system is free for chapter members if the chapter uses original educational content, there is a fee for the contact hour if a chapter uses ACRP-derived educational content. Click here to confirm pricing for contact hours.

Yes
No

Contact Email

If you need a certificate template with this event information included for attendee self-reporting for the event, please provide the contact information for the individual preparing the certificates for the attendees here.

Section III - Request for Online Registration Support

Complete this section if you would like ACRP to set up an event registration web page for your event.

Event Maximum Capacity for registration (if applicable)

Last Day to Register Online

Chapter member registration fee (if applicable)

ACRP Member (no chapter) registration fee (if applicable)

Non-member registration fee (if applicable)

Cancellation fee (if applicable)

Do you want ACRP to add this event to the event calendar on the ACRP website?

This will be added here once the registration is live.

Yes
No

Name

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

Support the ACRP Ride4DEI

Chapter Event Support Form

Chapter Event Support Request

Required Information

Section I - Request for Educational Content Approval for Contact Hours

Section II - Request for ACRP Contact Hour Management

Section III - Request for Online Registration Support