2023 Annual Meeting Speaker Confirmation

The purpose of this letter is to formally invite you, on behalf of Drs. Elizabeth Scholzen and Katherine Kozarek, Co-Chairs of the 2023 Wisconsin Society of Anesthesiologists (WSA) Annual Meeting, to speak at our upcoming meeting held from September 9-10, 2023, at the Hyatt Regency in Green Bay, WI. The overall theme of this year’s meeting is “Cliniical Controversies in Anesthesia: Challenging the Status Quo.” A program outline is enclosed indicating presentation times and topics.

Speaker Registration

First Name: *

Last Name: *

Credentials: *

Affiliation: *

E-mail address: *

Mobile Number: *

Presentation Title: *

My title in the program brochure is correct.

My title needs to be revised (see below). My title needs to be revised (see below).

Short Biography (for promotional purposes):

Headshot (for promotional purposes):

Social media handles (Facebook, Twitter, LinkedIn, Instagram) (for promotional purposes):

CME Disclosure Information

The WSA is obtaining Continuing Medical Education (CME) accreditation through the ACCME for its Annual Meeting. To comply with standards, all speakers must complete an industry disclosure form. Speakers are able to complete their disclosure online by clicking here.

CME Disclosure: *

I have completed my CME disclosure.

Meeting Registration & Travel Arrangements

As a speaker, the WSA will register you for the meeting and make any necessary hotel reservations for you at the Hyatt Regency. Please indicate below if you will need overnight accommodations. You will receive a confirmation number for your hotel reservation closer to the date of the meeting.

The WSA will also reimburse mileage as determined by the IRS and/or a roundtrip coach class airfare, booked at least 30 days in advance, not to exceed $500. The WSA will not make airline reservations, but will assist in coordinating transportation from the airport to the hotel, if needed. A reimbursement form is enclosed. Please complete and submit to the WSA office via email to marie@thewsa.org within 30 days after the meeting concludes. Receipts for all expenses MUST accompany your reimbursement form.

Hotel Accommodations: *

Yes, I DO need overnight accommodations.

No, I do NOT need overnight accommodations.

Arrival Date:

Departure Date:

Board & Speaker Dinner - Friday, September 8

The WSA will be hosting a dinner for the Board and invited speakers on Friday, September 8 at a location to be announced in Green Bay, WI.

Dinner Attendance: *

YES, I will be attending dinner.

NO, I am UNABLE to attend.

Dietary Restrictions or Other Special Needs:

Optional Saturday Event

Join the WSA for a tour of Lambeau Field during the Annual Meeting on Saturday, September 9, 2023 at 5:30pm. Tickets are $125 per person and includes dinner following the tour. Transportation to and from the tour will be provided via bus from the Hyatt.

Tour/Dinner Attendance: *

YES, I'm interested in attending the tour followed by dinner ($125 ea). Please invoice me.

NO, I am NOT interested in attending.

# of Tickets:

Transportation Needs:

YES, I plan on taking advantage of the provided bus transportation from the hotel.

NO, I will arrange my own transportation.

Presentation Information

Due Tuesday, September 5, 2023

Please submit your PowerPoint presentation to the WSA office by email to marie@thewsa.org. Unless you choose not to share your presentation, the WSA will generate your PowerPoint into a PDF and post to the website. If your presentation includes any copyright or sensitive material (i.e. stock photos you have not purchased or found via the Internet, patient photos, private information), please let the WSA office know. We will confirm receipt of all documents.

I will submit my PowerPoint presentation by Tuesday, September 5, and notify the WSA office of any copyright or sensitive material that should not be posted to the WSA website. *

I agree.

I do NOT agree.

Short presentation summary (for promotional purposes):

Thank You!

Thank you once again for agreeing to speak at the WSA 2023 Annual Meeting! If you have any questions, please do not hesitate to contact the WSA office at 414-389-8616 or by email at marie@thewsa.org.

Sincerely,
Marie Odden
Executive Director
Wisconsin Society of Anesthesiologists

Wisconsin Society of Anesthesiologists

6737 W Washington St, Ste 4210, Milwaukee, WI 53214

P: (414) 389-8616 | F: (414) 755-1346

info@thewsa.org | www.thewsa.org