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ASFA 2018 Regional Meeting Moderators
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Thank you for accepting the Organizing Committee’s invitation to be a moderator at the ASFA 2018 Regional Meeting, September 7, 2018 at the UC College of Medicine, Kresge Auditorium in Cincinnati, Ohio.

We look forward to your participation and ask you to provide all of the required information to confirm your acceptance. 

There are two forms to complete. Please complete the required fields below and click Submit to load the Disclosure Form.

  • Speaker Letter of Agreement (below) 
  • Disclosure Form 



  1. I agree to present at the ASFA 2018 Regional Meeting on September 7, 2018, in Cincinnati, Ohio, and will address the title and topic information as requested.
  2.  I understand that in order to provide the participants with handouts for the session, I will need to comply with the submission deadlines listed.
  3. During my presentation, I will not engage in any type of promotional marketing or selling of any product or service.
  4. I agree to notify the program manager immediately in the event that an emergency should prevent me from meeting my obligation as a speaker.
  5. I grant ASFA a nonexclusive, irrevocable worldwide license to use, reproduce, make derivative works, publish, distribute, and/or sell the recording, transcript, and/or handouts and related materials of my presentation. I understand that this license does not prohibit me from using my presentation in the future in my own professional or personal work. The undersigned further grants the association the rights to edit, film, record, publish, reproduce, reprint, distribute, sell, and otherwise make use of the work.
  6. I warrant and represent that, to the best of my knowledge; nothing in my presentation violates any proprietary or personal rights of others (including, without limitation, any copyright or privacy rights); is factually accurate, and contains nothing libelous or otherwise unlawful.
  7. I further warrant and represent that my presentation is my own original work, that I have the authority to enter into this Agreement, and that I am the sole copyright holder or that I have obtained all necessary permissions or licenses from any persons or organizations whose material is included or used in my presentation.
  8. I authorize ASFA to use my name, likeness, photograph, and biographical data in connection with the use and promotion of the conference and my presentation.

By entering my name below, I authorize ASFA to post the materials I present at the ASFA 2018 Regional Meeting, September 7, 2018, in Cincinnati, Ohio on the ASFA website in PDF format for the purposes of ongoing apheresis education.

Please enter your initials below to indicate your agreement.

Please confirm your name, designation(s)/degree(s), and organization as you wish it to appear on the Final Program.

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