2025 Webinar/On-Demand Speaker Information Form

Name

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

Name(Required)

First Last

Credentials(Required)

Company/Affiliation(Required)

Title/Position(Required)

Email(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What type of online session are you interested in providing in 2025?(Required)

Live Webinar

Recorded for On-Demand Access

Number of hours you would like to present/record:(Required)

1-2 CE Hours

3-4 CE Hours

5-6 CE Hours

7-8 CE Hours

9 or More CE Hours

Webinar/On-Demand Subject(s):(Required)

Example: Dentistry, Neurology, Practice Management, etc.

Please list potential sponsors for your presentation(s):

Please write “none” if you don’t have any potential sponsors.

Intended Audience:(Required)

Veterinarians

Technicians

Team Members

Lecture topics, titles, and/or abstracts:(Required)

Please upload your lecture topics, titles, and/or abstracts:(Required)

Accepted file types: doc, docx, pdf, png, jpg, Max. file size: 256 MB.

Please upload your headshot photo:(Required)

Accepted file types: jpg, png, Max. file size: 256 MB.

jpg file size should be 1 MB or greater.

Please upload your narrative biography:(Required)

Accepted file types: doc, docx, pdf, png, jpg, Max. file size: 256 MB.

Please upload your curriculum vitae/resume:(Required)

Accepted file types: doc, docx, pdf, png, jpg, Max. file size: 256 MB.

Please upload your W9 Tax Form:

Max. file size: 256 MB.

Required if Honorarium is being paid by the FVMA/FAEP.

FVMA Webinar/On-Demand Speaker Information Form