Satellite Symposium Application Form

"*" indicates required fields

Satellite Symposium Faculty

The ANA Satellite Symposium guidelines require symposia to be well balanced. Diverse faculty representation regarding gender, race, and ethnicity is required. Please list your proposed symposium faculty below ensuring these policies are adhered to.

If you do not know your faculty or panel member(s) at this time, please list potential faculty. Faculty will need to be disclosed before your application is approved and your session date is assigned by the ANA.

Chair/Moderator #1*

Name Credentials

Title*

Institution*

Address*

City State

Email*

Chair/Moderator #2

Name Credentials

Title

Institution

Address

City State

Speaker #1*

Name Credentials

Title*

Institution*

Address*

City State

Email*

Speaker #2 (if applicable)

Name Credentials

Title

Institution

Address

City State

Speaker #3 (if applicable)

Name Credentials

Title

Institution

Address

City State

Speaker #4 (if applicable)

Name Credentials

Title

Institution

Address

City State

Satellite Symposium Program

Symposium Title*

Symposium Description*

Learning Objectives*

Include at least three (3) specific, measurable learning objectives that define intended outcomes for the audience.

Agenda*

Will you be offering CME/CE credit for this event?*

Yes

Please provide the name of accredited providers that will award CME/CE credit(s).*

Number of Credits*

Please enter a number from 0 to 20.

Has your organization hosted a Satellite Symposium at the ANA Annual Meeting in the last three years?*

Yes

Please explain how your proposed 2025 symposium differs from the previous symposia.*

Commercial Support

Please list any source of commercial grant support for the proposed Satellite Symposium.

List any notes or comments for the ANA Industry Innovations Workgroup to be aware of during their review process below (e.g., status of faculty invitations, etc.).

Policies, Terms & Conditions

Consent

I Agree

By submitting a Satellite Symposium Application, the Certified CME/CE Provider and Commercial Supporter (if applicable) agree to the Policies, Terms & Conditions included in the ANA Exhibitor & Sponsorship Prospectus. Both parties also agree with the guidelines outlined in all supporting documentation.

The submission of a Satellite Symposium Application is an offer to ANA to host a symposium during the ANA Annual Meeting. ANA reserves the right in its sole discretion to refuse to accept any Satellite Symposium Applications.

Signature

The person signing the Satellite Symposium Application shall be deemed to have full authority to do so and shall have no right to claim against the ANA that such person or persons did not have such authority.*

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