TMA Presentation Request

TMA Presentation Request
Welcome!

This form is for organizations requesting a presentation from Texas Medical Association (TMA) at their event. All requests must be submitted through this online form. The person completing the form should be the primary point of contact, responsible for receiving all communications and providing any required information or documentation.

Before You Begin
- To avoid an expediting fee, requests must be submitted at least 45 days before the activity's scheduled date.
- If you have a previous activity with missing required documentation or an outstanding payment, a new request may be declined until complete.
Before You Submit Your Request

Review the following requirements. You will be asked to confirm your agreement after reviewing the fee schedule on the next page.
1. TMA Educational Presentation Request Agreement to Terms and Conditions – You must agree to the TMA Educational Presentation Request Agreement to Terms and Conditions.
2. Fee Schedule – Please review the applicable fees for educational presentations.
3. Registration – You must track registration and submit the data to TMA before the event.
4. Attendance Requirements – An attendance sheet is required for all activities. Each sheet must include the following for every participant:
  • Full name
  • Email address
  • Medical license number for physicians
  • Role/Title for nonphysicians
5. Onsite Representation – TMA may choose to have a membership representative attend the presentation/event. You will be contacted if a representative is scheduled to attend.
How to Save and Resume Later

If you need to pause and complete the form at a later time, follow these steps to save your progress:
- Click the SAVE button located at the bottom of the form. This will open a pop-up window.
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- Check your email inbox for a message from JotForm containing your unique link to resume the form.
- When you're ready to return, simply click the link in your email to pick up where you left off.
If you do not see the email, please check your spam/junk folder.

Questions?

Please contact us at cme@texmed.org for assistance.
Organization Type and Name

Select the type of organization requesting the presentation and enter the organization's name. If you are completing this form on behalf of another organization, select the type that best describes the organization you are representing. Not sure if the organization is a 100% Membership Group? Click the link to verify: 100% Membership Groups
Organization Type*

County Medical Society100% Membership GroupResidency ProgramAll other organizations/groups
Name of organization*
Enter the full name without abbreviations.

TMA Presentation Fee Schedule – County Medical Societies

Ambassador Program
TMA provides a diverse range of presentations covering topics including advocacy and public affairs, communications, organized medicine/membership, payment, and practice management. A CMS can request up to six presentations per year, once every two months. You may include one presenation from the Wellness First Program as part of the total six presentations.
Fee: $0

Wellness First Program
TMA provides a selection of self-care and wellness presentations.
Fee: One complimentary presentation (includes honorarium and travel expenses)
Additional presentations: $1,200 (1-hour) plus travel expenses

On-Demand (Not Available at This Time)
TMA offers several on-demand, single-use presentations for CME credit, focusing on physician health and wellness and leadership. Each quarter, we introduce five new topics, with the option to substitute an approved topic as needed.
Fees:
• Tier 1: $750 for 1–25 people
• Tier 2: $1,000 for 26–100 people
• Tier 3: $1,500 for 101+ people
Additional Fees: If more than 30% of participants are non-members: $500 (Tier 1), $750 (Tier 2), $1,000 (Tier 3)

Other TMA Presentations
Certain TMA staff members offer presentations tailored to specific audiences, typically coordinated directly with the staff member. Each presentation lasts 45 to 60 minutes and, when available, includes a one-page summary of key points. If you are working directly with a TMA staff member to coordinate a presentation, please select this option later in the form.
Fees:
• Onsite: $900* or $1,200 (plus travel expenses)
• Virtual: $300* or $600
*Discounted Fee: If TMA physician members comprise more than 70% of your audience, you qualify for a discounted fee of $900 for an on-site presentation and $300 for a virtual presentation

Expedite
If a request is submitted after the deadline, which is a minimum of 45 days before the scheduled activity date, an expediting fee will be charged if TMA is able to accommodate the request.
Fee: $100

Cancellation
If the activity is cancelled less than seven days before the activity, the applicant will incur any non-refundable speaker travel expense and honorarium, if applicable.
Fee: Varies
TMA Presentation Fee Schedule – 100% Membership Groups

Ambassador Program
TMA provides a diverse range of presentations covering topics including advocacy and public affairs, communications, organized medicine/membership, payment, and practice management.
Fee: $0

Wellness First Program
TMA provides a selection of self-care and wellness presentations.
Fee: One complimentary presentation (includes honorarium and travel expenses)
Additional presentations: $1,200 (1-hour) plus travel expenses

On-Demand (Not Available at This Time)
TMA offers several on-demand, single-use presentations for CME credit, focusing on physician health and wellness and leadership. Each quarter, we introduce five new topics, with the option to substitute an approved topic as needed.
Fees:
• Tier 1: $750 for 1–25 people
• Tier 2: $1,000 for 26–100 people
• Tier 3: $1,500 for 101+ people
Additional Fees: If more than 30% of participants are non-members: $500 (Tier 1), $750 (Tier 2), $1,000 (Tier 3)

Other TMA Presentations
Certain TMA staff members offer presentations tailored to specific audiences, typically coordinated directly with the staff member. Each presentation includes 45 to 60 minutes of content and a copy of the presentation slides. If you are working directly with a TMA staff member to coordinate a presentation, please select this option later in the form.
Fees:
• Onsite: $900* or $1,200 (plus travel expenses)
• Virtual: $300* or $600
*Discounted Fee: If TMA physician members comprise more than 70% of your audience, you qualify for a discounted fee of $900 for an on-site presentation and $300 for a virtual presentation

Expedite
If a request is submitted after the deadline, which is a minimum of 45 days before the scheduled activity date, an expediting fee will be charged if TMA is able to accommodate the request.
Fee: $100

Cancellation
If the activity is cancelled less than seven days before the activity, the applicant will incur any non-refundable speaker travel expense and honorarium, if applicable.
Fee: Varies
TMA Presentation Fee Schedule – Residency Programs

Early Career Education for Residents

A diverse range of presentations available for residency programs.
Fee: $0

Wellness First Program

TMA provides a selection of self-care and wellness presentations.
Format: Virtual only
Fee: $0

On-Demand (Not Available at This Time)
TMA offers several on-demand, single-use presentations for CME credit, focusing on physician health and wellness and leadership. Each quarter, we introduce five new topics, with the option to substitute an approved topic as needed.
Fees:
• Tier 1: $750 for 1–25 people
• Tier 2: $1,000 for 26–100 people
• Tier 3: $1,500 for 101+ people
Additional Fees: If more than 30% of participants are non-members: $500 (Tier 1), $750 (Tier 2), $1,000 (Tier 3)

Other TMA Presentations
Certain TMA staff members offer presentations tailored to specific audiences, typically coordinated directly with the staff member. Each presentation includes 45 to 60 minutes of content and a copy of the presentation slides. If you are working directly with a TMA staff member to coordinate a presentation, please select this option later in the form.
Fees:
• Onsite: $900* or $1,200 (plus travel expenses)
• Virtual: $300* or $600
*Discounted Fee: If TMA physician members comprise more than 70% of your audience, you qualify for a discounted fee of $900 for an on-site presentation and $300 for a virtual presentation

Expedite
If a request is submitted after the deadline, which is a minimum of 45 days before the scheduled activity date, an expediting fee will be charged if TMA is able to accommodate the request.
Fee: $250

Cancellation
If the activity is cancelled less than seven days before the activity, the applicant will incur any non-refundable speaker travel expense and honorarium, if applicable.
Fee: Varies
TMA Presentation Fee Schedule – External Organizations

Wellness First Program

TMA provides a selection of self-care and wellness presentations.
Format: In-person
Fee: $1,200 (includes 1-hour presentation, honorarium, and travel expenses)

On-Demand (Not Available at This Time)
TMA offers several on-demand, single-use presentations for CME credit, focusing on physician health and wellness and leadership. Each quarter, we introduce five new topics, with the option to substitute an approved topic as needed.
Fees:
• Tier 1: $750 for 1–25 people
• Tier 2: $1,000 for 26–100 people
• Tier 3: $1,500 for 101+ people
Additional Fees: If more than 30% of participants are non-members: $500 (Tier 1), $750 (Tier 2), $1,000 (Tier 3)

Other TMA Presentations
Certain TMA staff members offer presentations tailored to specific audiences, typically coordinated directly with the staff member. Each presentation includes 45 to 60 minutes of content and a copy of the presentation slides. If you are working directly with a TMA staff member to coordinate a presentation, please select this option later in the form.
Fees:
• Onsite: $900* or $1,200 (plus travel expenses)
• Virtual: $300* or $600
*Discounted Fee: If TMA physician members comprise more than 70% of your audience, you qualify for a discounted fee of $900 for an on-site presentation and $300 for a virtual presentation

Expedite
If a request is submitted after the deadline, which is a minimum of 45 days before the scheduled activity date, an expediting fee will be charged if TMA is able to accommodate the request.
Fee: $250

Cancellation
If the activity is cancelled less than seven days before the activity, the applicant will incur any non-refundable speaker travel expense and honorarium, if applicable.
Fee: Varies
Confirmation of Agreement*

By checking this box, organization agrees to the TMA Educational Presentation Request Agreement to Terms and Conditions, Registration Requirements, Attendance Requirements, Onsite Representation, and Fee Schedule.

Primary Contact
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

CityState

Zip Code
The address provided above will be used to ship presentation and marketing/membership materials for the event, if applicable.
Is the billing information the same as the applicant's information?*

YesNo
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.

Presentation Category and Title

Please select one presentation per submission. To view available presentations, click the link for each category listed below. Use the first dropdown menu to select your category, then choose your presentation from the second dropdown. If you are requesting a presentation that is not listed, select "Other TMA Presentation" and specify the title and TMA staff contact. All presentations are approximately one hour in length, with some offering AMA PRA Category 1 Credit™, while others do not.
- Ambassador Program (TMA website login required)
- Wellness First Program
- Other TMA Presentation
- Early Career Education for Residents
- Wellness First Program
- Other TMA Presentation
- Wellness First Program
- Other TMA Presentation
Presentation Title*
TMA Staff Contact*
Imporant Note: CME Credits will not be provided for residency program activities.

Reviewer Notes
Should be Empty: