Event Endorsement Request

First Name *

Last Name *

Professional Title *

Organization or Institution *

Email *

Telephone *

ASN Membership Status *

Active ASN Member

Non-Member

Unsure

Event Information

ASN member(s) involved in the event, if different from applicant

ASN member's role in planning or organizing the event

Event Title *

Organizing institution, organization, or society *

Event date(s) *

Event location *

In Person

Virtual

Hybrid

Event website

Expected number of participants

Target audience

Brief description of event (please include if CME or not) *

Educational objectives

Program Content

Does the program include education in the following areas? *

Transcranial Doppler

Carotid Ultrasound

Neuroimaging

Other

For programs focused on TCD or Carotid Ultrasound, provide the name of credentialed faculty member

Faculty credentials

RPNI

NVS

Please provide us with content related to the event to share in ASN newsletter and social media. Please note this content may be modified for space or media/graphic restrictions.

Requested content for newsletter and website (100 words max) *

Requested content for social media (LinkedIn, Facebook)

Requested content for social media (Twitter/X)

Endorsement Fee

Payment of the endorsement fee does not guarantee approval

I am an active ASN member and qualify for complimentary endorsement

I am a non-member and agree to pay the $100 endorsement fee before review

Required Attachments

Please upload: 1. Preliminary or final program that includes CME information 2. Faculty list with credentials 3. Educational objectives 4. Draft marketing and promotional materials

Upload Files

Applicant Agreement

I confirm that the information provided is accurate. If endorsement is approved, I agree to: • Display the ASN endorsement logo on relevant marketing and promotional materials. • Use only the logo files supplied by ASN and follow ASN branding and logo-use requirements. • Notify ASN promptly of event cancellation or major program changes that impact endorsement. • Avoid language suggesting that ASN provides CME accreditation, financial sponsorship, or responsibility for the event. • Discontinue use of the ASN name and logo if endorsement is withdrawn. • Ensure that the event complies with all applicable professional, ethical, and CME standards. This includes appropriate management of faculty disclosures and conflicts of interest; balanced, evidence-based content free from inappropriate commercial influence; consideration of professional and demographic diversity; and all necessary permissions for patient images or clinical materials

Please type your name and date if you agree to the above . This will serve as your electronic signature.

Data Privacy & Consent

Yes, I would like to receive communications from American Society of Neuroimaging by email.