Speaker Forms

Thank you for participating in the Midwest Clinical and Translational Research Meeting!

In order to pay your honorarium, we need a completed W-9.
Upload or mail or fax to:
555 E. Wells Street, Ste. 1100
Milwaukee, WI 53202
Fax: (414) 276-2146
You may email to jwilhelms@csctr.org however we cannot guarantee the security of email. 

Program Schedule

CME Disclosure

Everyone participating in the planning and delivery of this activity (planners, speakers, authors, moderators, staff, abstract reviewers, etc.) MUST disclosed.  Missing disclosures may result in loss of CME credit, even retroactively.

Travel Reimbursement Policy

Meeting speakers will receive reimbursement of ordinary and reasonable expenses related to traveling to the meeting.  Reimbursable expenses include:

  • Coach airfare purchased at least 21 days in advance (February 10, 2022), train fare, or mileage, if driving;
  • Up to two (2) night’s hotel at the official host hotel;
  • Ground transportation (taxi, Uber, public transportation, etc.);
  • Rental cars not reimbursed;
  • Parking fees. 


  1. You are required to submit all original receipts, regardless of dollar amount, in order to be reimbursed. 
  2. Retain itemized receipts for your travel expenses and include tip, if applicable, on the receipt.
  3. Electronic Receipts (e-receipts) are encouraged and acceptable to CSCTR.  
  4. Scanned or photographed paper receipts, provided it is readable, are also acceptable.
  5. Submit expenses within 30 days of the event.

Travel arrangements:

  1. Coach air or train fare must be purchased at least 21 days in advance (February 10)
    1. Fees and/or fare increases incurred due to changes in already purchased fare(s) will not be reimbursed.
    2. CSCTR must pre-approve changes to your already purchased travel itinerary for reimbursement exception.
  2. If driving, mileage will be reimbursed at the IRS rate – currently 58.5 cents per business mile driven;
    1. Submit the route (via Google Maps, Mapquest, etc.) showing the total miles between your home/office and the Meeting venue.


  1. CSCTR is holding a block of rooms for the speakers. Please make your own hotel reservations and staff will transfer the charge to CSCTR. 
  2. The cost of the hotel room and tax will be charged to the CSCTR Master Account.  However, incidentals are your responsibility and the hotel will require a credit card at check-in.
  3. Only hotel rooms provided via the CSCTR Room block will be paid.

CSCTR Speaker Expense Form

Speaker Bios