Setup an Audio Conference/Webinar

Please complete the information below if you would like to set-up an audio seminar for your association and market it in the Learning Portal.

Questions? Email us at info@knowledgeconnex.com or call 888.391.0977

*Association Name
Contact (Admin) Info:
*First Name
*Last Name
*Email
*Phone

About the Audio Seminar
*Date
*Start Time
*End Time
*Time Zone
*Title of Seminar
Description/Overview of the Seminar
*Estimated Number of Attendees	including speaker(s)
*Number of CEs Offered
Would you like an online evaluation and CE* provided for your attendees?
Yes (Please email your CE certificate to us) No

Registration Information
Pricing
Member	$
Non-Member	$
Student	$
Senior	$
Do you need a customer code for a discounted or free registration? Please explain.

Please provide the following:
Speaker Name
Phone Number	Phone number where the speaker can be reached by the operator 15 minutes prior to the call for the pre-conference.
Email
Speaker Bio	If you would like to provide at a later time, please email the information to info@knowledgeconnex.com

Additional moderators/co-presenters to be called during the pre-conference. If you would like to provide at a later time, please email the information to info@knowledgeconnex.com *If the moderators/co-presenters need to receive the evaluation and CE email after the call, please make sure that they register online. If they are no charge, then indicate this during online registration.
Name
Phone Number
Name
Phone Number
Name
Phone Number
Name
Phone Number

Web Capability
*Do you want a webinar also?
Yes No

Recording
*Do you want to record the audio seminar?
Yes, please record the audio only Yes, please record the audio and web No, do not record the audio or web

Handouts
* Have handouts been provided to KnowledgeConnex? Yes No We will need handouts on or before of the online registration close date. These will be emailed to the participant along with the access instructions prior to the call. Revenue Share Do you want to participate in the revenue share program with the other KnowledgeConnex associations? Yes No I don't know what this is. Please contact me.