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IMA Event Broadcast Request

This form is used to request the broadcast of an event nationally.
  • Submitter's Information

  • Date and Time

    Date and Time that you are conducting the webinar/event.
  • Date Format: MM slash DD slash YYYY
  • :
  • :
  • Topic

  • These are required if you want to issue CPEs for this webinar. If so, provide 3 or more learning outcomes/learning objectives for the topic. (In the format of "Upon completion of this webinar, the attendee/student will be able to _____________" (Three learning objectives are required for ASIS CPE credit) Please note that if you want to offer CPE, your IMA needs to be the one to prepare and issue the certificate for this.
  • Presenter Information

  • BIO: (Tell us briefly about the speaker. Occupation? Experience with topic? Any honors or distinctions? Recent work? Why are they wantingregistering to present?)*
  • BIO: (Tell us briefly about the speaker. Occupation? Experience with topic? Any honors or distinctions? Recent work? Why are they wantingregistering to present?)*
  • BIO: (Tell us briefly about the speaker. Occupation? Experience with topic? Any honors or distinctions? Recent work? Why are they wantingregistering to present?)*
  • BIO: (Tell us briefly about the speaker. Occupation? Experience with topic? Any honors or distinctions? Recent work? Why are they wantingregistering to present?)*
  • Describe who would benefit from attending this webinar, what job classifications, roles, sectors, etc.
    Select from below to indicate if this webinar is ONLY for InfraGard members, for InfraGard members and their specific guests, or if the webinar is open to anyone.
  • Include here any other notes or information INMA would need to process this broadcast.
  • Include here any other notes or information INMA would need to process this broadcast.
  • This field is for validation purposes and should be left unchanged.
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