Webinar Design Form

Committee
Please select the committee for which you are submitting a webinar proposal.
- Constitution & Bylaws
- History
- International
- Membership & Credentials
- Research
- Surgical Education
- Value Based Healthcare
- Website & Communications
Committee Member Contact Information
Please complete contact information for the member leading the planning of the webinar.
Committee Member Name*
First (Given) Name Last (Family) Name
Committee Member Email*
Webinar Information
Webinar Title*
Webinar Description*
Provide 3-5 sentences describing the webinar, including target audience.
Proposed Date*
To ensure proper planning it is recommended webinars be planned for 4-6 weeks away from the date of submitting the proposal. If approved the NASBS will make every effort to accommodate the proposed date, though we reserve the right to change the date depending on other society activities.
MM slash DD slash YYYY
Webinar Objectives

Write at least three objectives focusing on what the learners will do as a result of this webinar. Use ACTION words like:

• Adjust
• Articulate
• Classify
• Convey
• Diagnose
• Distinguish
• Hypothesize
• Infer
• Organize
• Prioritize
• Relate

• Apply
• Assess
• Compare
• Create
• Diagram
• Employ
• Identify
• Integrate
• Plan
• Produce
• Select

• Appraise
• Categorize
• Conduct
• Demonstrate
• Differentiate
• Evaluate
• Illustrate
• Interpret
• Predict
• Recognize
• Solve

• Arrange
• Choose
• Construct
• Develop
• Discriminate
• Formulate
• Implement
• Manage
• Prepare
• Recommend
• Use

Select the number of webinar objectives you will write:*
Webinar Objective 1*
Webinar Objective 2*
Webinar Objective 3*
Webinar Objective 4*
Webinar Objective 5*
Webinar Moderators
Please enter the names and email addresses of the moderators who should be invited to this webinar.
Moderator 1*
First (Given) Name Last (Family) Name
Moderator 1 Email
Moderator 2*
First (Given) Name Last (Family) Name
Moderator 2 Email
Webinar Outline
Outline
Please use the Add Activity button to add a speaker, break, etc. to the session outline.
Activity Order Title of Presentation or Activity Presenter/Faculty Name Time allotted in minutes for this activity Actions
There are no Activities.
Maximum number of activities reached.
Special Requests
Please list any special requests here.
Email
This field is for validation purposes and should be left unchanged.

Activity Order	Title of Presentation or Activity	Presenter/Faculty Name	Time allotted in minutes for this activity	Actions

There are no Activities.

Committee Member Contact Information