Policy Committee Meeting 12.4.23

7173 S. Havana St. |#600-130 Centennial, CO 80112 P: 303.770.2526 | F: 303.779.4834 obesitymedicine.org

SPEAKER ENGAGEMENT CONTRACT Obesity Medicine Association

SPEAKER INFORMATION: Please list the following information as you would like it to appear in conference materials. Name: Credentials: Current Title: Mobile Phone: Email: Address:

Current Employer:

SECTION 1: CONTRACT INFORMATION SPEAKER ENGAGEMENT : This agreement is between Obesity Medicine Association ("OMA" or "us") and

whereby OMA agrees to hire Speaker under the terms and conditions outlined below.

Session Title/Engagement:

In-Person Session Date:

Session Time:

Location:

CONTRACT TERMS REGISTRATION FEE: The following registration is waived, contingent on meeting deadlines. Review Course for the ABOM Exam: Spring Obesity Conference:

Culinary Medicine Workshop:

Fundamentals of Obesity Treatment:

HONORARIUM

The speaker will be paid an honorarium of $ in accordance with the Speaker Reimbursement Travel Policy . Honorarium and travel stipend will be paid after the agreed upon deliverables within this speaker agreement are satisfied. If deliverables are not met within the designated timeline/ deadline, honorarium is subject to decrease by 50% each for each 7 days the deadline has passed. and will receive a travel stipend of $

Entity/Person to receive honorarium/travel stipend:

This entity to be paid must match the Tax ID information and entity to be paid listed on the W9 form submitted with this contract. The speaker agrees to submit a completed W9 prior to the start of the event.

Initial here: