1 Start 2 Page 2 3 Preview 4 Complete The purpose of this form is to assist you with Webinar details for your up-coming continuing education activity. Once approved by CE Programs, the form will be submitted to Video Services (OCC). Requests made to OCC prior to CE Programs approval will be denied. Activity Title * Activity Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20172018201920202021 Time of Activity (Start) * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Time of Activity (End) * Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Presenter Name/s with Credentials * Estimated number of participants * Participants cannot use audio/video. Only the presenter can be seen/heard. There can be up to 25 presenters who can use audio/video. Includes polling, registration and Q&A capabilities 1-50 51-200 201 - 3000 Would you like to add polling questions? * BAYADA Video Services (OCC) will moderate the webinar - Select - Yes No List questions to include in poll. * Would you like BAYADA Video Services (OCC) to moderate the webinar * Moderating by BAYADA Video Services (OCC) provides technical assistance. - Select - Yes No Your form is complete. Click "Preview" on the next page to review. Leave this field blank
