Live Laser or Device Demonstration

If your company is supporting a live laser or device demonstration, complete the form below by November 15, 2017.

Application/Procedure*
Type of Device*
Electrical Requirements*
Ex. 230 VAC/30 A
System Cooling
Requested Demonstrator(s)*
Does this device require a warm-up period before use?*
- Yes
- No
Does this device require pipe and drape or goggles?*
- Yes
- No
Will you be submitting any research for the ODAC Poster Session?*
- Yes
- No
General supplies needed for live demo - Gloves:
- We will supply gloves
- Please supply latex
- Please supply non-latex
If we need to supply gloves, indicate the size below
General supplies needed for live demo - Goggles:
- We will provide goggles for this session
- Goggles are not needed for this session
General supplies needed for live demo - Gel:
- We will provide gel
- Gel is not needed for this procedure
This demonstration should be performed behind a curtain:*
- Yes
- No
Please specify all other general supplies needed for demonstration of this type
Number of patients needed:*
Do you have a preference for patient type? This will also be confirmed with the demonstrator. Describe criteria/characteristics.
Would you like to bring your own patient?*
- Yes
- No
If you will be bringing your own patient, provide their information below.
Name Phone Number Email
Company Contact or Medical Assistant Name
Name Phone Number Email

Credit Designation Statement
The University of Chicago Pritzker School of Medicine designates this live activity for a maximum of 30 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses and other healthcare professionals will receive a Certificate of Participation. For information on the applicability and acceptance of Certificates of Participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME, please consult your professional licensing board.

The ODAC Conference (Program #276100) is recognized by the American Academy of Dermatology for 30 AAD Recognized Credit(s) and may be used toward the American Academy of Dermatology’s Continuing Medical Education Award.

Live Laser or Device Demonstration

Additional Info