SAMPLE V_CPD Action Form

Please be sure to read the Facilitation Terms and Conditions thoroughly before filling in the Action Form.

2024 Facilitation Terms & Conditions and Code of Conduct

Action Form - DUMMY FORM

"*" indicates required fields

Event Reference number*

PTCMA admin

Tracking*

PTCMA admin

Postponed from*

Facilitating Company Name*

Date*

Virtual

Time of session*

Morning Session: 09h00

Evening session: 19h00

Event Details

Primary Disease Area*

Choose most applicable

Secondary Disease Area

If applicable

Define other*

Topic

Please define abbreviations

Add-ons

NOTE: You need to choose one of the options below if you wish the session to be recorded. It will no longer be done by default. Should you wish to opt for a recording at a later stage, please inform the PTCMA in writing PRIOR TO THE SESSION.

Request recording WITH MCQs for CPD accreditation*

Cost R4 700.00 per hour (excl. VAT).
The recording will be uploaded to the Portal within a week after the event with the MCQ for CPD accreditation added within 4 weeks of the meeting.
The recording will be available to view for 12 months after the meeting.
The recording will be sent to the sponsor via WeTransfer.
The sponsor will receive a voucher valid for 50 users to distribute to non-members in order to view the recording.

By selecting 'Yes' you confirm that the presenter has granted permission for the recording.

Yes

Request recording ONLY*

Cost R2 200.00 per hour (excl. VAT).
The recording will be uploaded to the Portal within a week after the event.
NO CPD points will be awarded for viewing.
The recording will be available to view for 12 months after the meeting.
The recording will be sent to the sponsor via WeTransfer.

By selecting 'Yes' you confirm that the presenter has granted permission for the recording.

Yes

Request additional vouchers

Once the recording is uploaded to the PTCMA Portal, only PTCMA and SAMA members will be able to access the video.
To extend this reach we offer the opportunity to purchase voucher accesses for the co-facilitator to distribute as per the fees below.

None

100 individual accesses @ R3000.00

150 individual accesses @ R3750.00

200 individual accesses @ R4000.00

300 individual accesses @ R4500.00

500 individual accesses @ R5000.00

Additional presenters*

Single presenter

Two presenters

Three presenters

Please indicate if there will be more than one presenter or contributor.

Extend the meeting duration*

You can extend the session for an additional R 2 300.00 per 30 minutes. This is necessary should you wish to involve a patient advocate or second presenter.
Please remember that if the session extends 90 minutes and is being recorded, a recording fee for a second hour will be charged.

Do not extend

Extend with 30 minutes

Extend with 60 minutes

Co-Facilitator Details

Co-Facilitator is the sponsoring Corporate Member

Contact person 1 name*

First Last

Contact person 1 Email*

Contact person 1 mobile number*

Contact person 2 Name*

First Last

Contact person 2 Email*

Contact person 2 mobile number*

Email address to share with participants

Please submit an email address we can share with participants in the chat in the meeting, at the end of the recording, in the 'thank you for attending' email, etc. where they can send questions to.
Leave blank if you do not wish us to share any details.

Presenter Details

It is important for us to have the direct contact details for the presenter in order that we can assist them in preparation for this meeting. The sponsor contact will be copied in all communication with the presenter.

Presenter Name*

Title First Last

Pronouns*

Preferred pronouns for introduction

Specialty*

Current position*

Qualifications*

HPCSA registration number*

Presenter Email*

Presenter cell phone number*

Presenter other phone number

Short presenter bio for introduction*

Permission for Zoom meeting*

The presenter has been informed and is in agreement to conduct this CPD meeting virtually using the ZOOM application.

Yes

Second Presenter Details

Presenter 2 Name*

Prefix First Last

Pronouns*

Preferred pronouns for introduction

Presenter 2 Current position*

Presenter 2 Specialty*

Presenter 2 Qualifications*

Presenter 2 HPCSA registration number*

Presenter 2 Email*

Presenter 2 cell phone number*

Presenter 2 other contact number

Short presenter 2 bio for introduction*

Permission for Zoom meeting for Presenter 2*

The presenter has been informed and is in agreement to conduct this CPD meeting virtually using the ZOOM application.

Yes

Third Presenter Details

Presenter 3 Name*

Prefix First Last

Pronouns*

Preferred pronouns for introduction

Presenter 3 Current position*

Presenter 3 Specialty*

Presenter 3 Qualifications*

Presenter 3 HPCSA registration number*

Presenter 3 Email*

Presenter 3 cell phone number*

Presenter 3 other contact number

Short presenter 3 bio for introduction*

Permission for Zoom meeting for Presenter 3*

The presenter has been informed and is in agreement to conduct this CPD meeting virtually using the ZOOM application.

Yes

Invoicing Requirements

Full Company Detail*

Company Name Address or PO Box City Province Area code

Accounts contact person*

First Last

Who should receive the Quote/Invoice?

Accounts contact number

Accounts Email*

Invoice Document Requirements*

We need:

Tax Invoice

Quotation, followed by an Invoice

Specific Description on the Invoice

Default is "Facilitating Virtual CPD Event". If you would like to change it or add to it, please supply detailed wording

Sponsoring company pays the honorarium directly to the presenter(s)*

Yes

Presenter Banking Details

Account name Account number Bank Branch code Type of account

Second Presenter Banking Details

Account name Account number Bank Branch code Type of account

Third Presenter Banking Details

Account name Account number Bank Branch code Type of account

Change the honorarium amount*

Yes

Sponsoring breakdown

Facilitation*

Price:

Additional half hour Facilitation

Price:

Fee to extend the session with 1/30 hour

Additional hour Facilitation

Price:

Fee to extend the session with 1 hour

Standard Honorarium*

Price:

Standard Honorarium for Second Presenter*

Price:

Custom Honorarium*

Custom Honorarium for second presenter*

Custom Honorarium for third presenter*

Recording fee with MCQs

Price:

Recording fee only

Price:

Recording fee with MCQs

Price:

Recording for 2 hours

Recording fee only

Price:

Recording for 2 hours

Voucher - 100 accesses

Price:

Voucher - 150 accesses

Price:

Voucher - 200 accesses

Price:

Voucher - 300 accesses

Price:

Voucher - 500 accesses

Price:

Subtotal

R0.00

VAT

R0.00

Total

Consent*

I agree to the Terms and Conditions

Virtual CPD (V_CPD) Facilitation via Zoom
Terms & Conditions 2024

1. Principles:
1.1 This is a neutral education platform for clinical discussion and all stakeholders represented must be respected and honoured.
1.2 The common goal of the Parties is to share evidence-based information to promote optimal patient care in the South African healthcare environment.

2. General:

2.1 The sponsorship is unconditional and provided by the Sponsor hereafter referred to as the Co-Facilitator.
2.2 Standard PTCMA Members will be allowed 1 (one) V_CPD sponsorship per annum. Corporate PTCMA Members can initially book 6 (six) dates to sponsor events. Requests for additional events will be considered based on capacity.
2.3 V_CPDs will be open to all Full Registrants (PTCMA members and other groups identified on the PTCMA Portal).
2.4 An invitation is circulated to all Full Registrants on the PTCMA Portal, which may include healthcare funders, academics, clinicians from the Public Healthcare Sector and Department of Health, healthcare industry regulatory bodies, and representatives from pharmaceutical and/or medical technology companies.
2.5 The Co-Facilitator may invite an additional 100 (one hundred) Guests to attend free of charge – a PDF of the invitation with a unique registration code will be sent to the Co-Facilitator for this purpose. It is the responsibility of the Co-Facilitator to send this invitation to its Guests. Only the first 100 (one hundred) Guests with the registration code submitted will be approved to attend (unless they are already Full Registrants on the PTCMA Portal, in which case they will not require a Guest registration, but will automatically be granted access to the event).
2.6 Appropriate topics - clinical or general - for the V_CPD can be suggested by the Co-Facilitator and agreed with the PTCMA Management.
2.7 If more than one V_CPD is booked by a Co-Facilitator in a year for the same disease area, the focus of discussion must be unique.
2.8 Appropriate independent presenters – e.g., academics, clinicians, and specialists can be suggested by the Co-facilitator and agreed with the PTCMA Management. Presenters who are employees of the Co-facilitator at the time of the event will only be considered in exceptional circumstances, such as where the subject matter pertains specifically to their expert roles within the Co-facilitator’s organisation (e.g., an expert on value-based contracting for a V-CPD co-facilitated by a Funder). Where the subject matter is mainly clinical in nature, an independent clinical expert in that particular field should be proposed.
2.9 The Co-Facilitator takes responsibility for briefing the presenter prior to the meeting on the topic format, meeting programme and audience, to emphasise the clinical nature of the forum, and to ensure strict adherence to The South African Code of Marketing Practice For Health Products Code & Guideline, the Principles stipulated in clause 1 of these Terms and Conditions, and, in particular, that
2.9.1 an unbiased, scientific evidence-based approach should be taken on discussing the disease/condition/intervention;
2.9.2 no health product promotion, branding (including product and company logos) or personal opinions are permissible except for the company logo on the disclosure slide described in clause 2.9.8;
2.9.3 speakers may only use the International Non-Proprietary Name of Health Products during CPD events; companies shall inform speakers that the use of trade names is not permitted;
2.9.4 discussions will focus on appropriate therapy or intervention options and sharing of a case study is encouraged;
2.9.5 unsolicited questions from participants on off-label use may be answered by regulatory, medical or other appropriately qualified personnel only (and not by sales and marketing Company Representatives);
2.9.6 no derogatory statements will be made against any healthcare funder, other company, organisation or doctor by name;
2.9.7 the presentation should be of at least 50 minutes duration to qualify for CPD accreditation; and
2.9.8 a slide should be included at the start of the presentation disclosing:
2.9.8.1 sponsorship of the presentation,
2.9.8.2 author conflicts of interest and relevant affiliations,
2.9.8.3 key contributors to the development of the presentation.
2.10 The Co-Facilitator shall ensure that the slide deck for the V_CPD event is shared via email with the PTCMA Programme Coordinator at no later than five working days prior to the event, for review against the requirements stipulated in clause 2.9.
2.10.1 Should the presentation not be submitted 24 hours before the scheduled start of the event to allow for possible adaptations, the PTCMA reserves the right to cancel the event and invoice the Co-facilitator for the full cancellation fee.
2.11 The Co-Facilitator takes responsibility for sending the confirmed event information to the PTCMA for circulation as per the timelines stipulated in clause 6.

3. Add-ons:
3.1 Recordings:
3.1.1 The Co-facilitator must obtain consent from the presenter to record the presentation.
3.1.2 The recording fee of a V_CPD Event does not include costs for editing. The Co-facilitator shall be responsible to ensure that the content of the presentation is compliant with the requirements stipulated in clause 2.9, and includes any disclaimers or other information to meet its internal compliance requirements prior to the event. Should editing be required to address violations of the requirements stipulated in clause 2.9, an editing fee of R800.00 per hour will be charged to ensure compliance of the recording before publication on the PTCMA Portal.
3.1.3 The recording will be hosted on PTCMA Portal for 12 (twelve) months and be accessible only to PTCMA members and Full Registrants on the PTCMA Portal.
3.1.4 A Multiple-Choice Questionnaire (MCQ) will be compiled for CPD accreditation if the option with MCQs is selected. CPD points for the recording will also be based on a 1 (one) point per hour basis.
3.1.5 The Co-Facilitator shall ensure that a PDF document of the presentation slide deck is sent by email to the PTCMA Programme Coordinator within five working days of the V-CPD event. Apart from the quality assurance check, this is to assist with compiling the MCQs and will be uploaded on the PTCMA Portal as a reference for participants completing the MCQs.
3.1.6 The recording will be sent to the Co-Facilitator via WeTransfer, unless an alternative electronic transferring facility is agreed on by both Parties.
3.1.6.1 Should the Co-facilitator wish to attach CPD points to viewing of the recording, it is required to select the recording option with MCQs and direct users to the PTCMA Portal via the voucher issued by the PTCMA – the Co-facilitator is not allowed to apply for CPD accreditation of the recording independently.
3.1.6.2 The Co-facilitator may use the copy of the recording strictly for internal company activities, i.e., in internal meetings and/or training, and/or the internal company website.
3.1.6.3 The Co-facilitator is not allowed to share this recording on a competing platform, including DeNovo Medica, EM Guidance, MPC, FPD, or similar organisations.
3.1.7 Annually, a report on the number of views and MCQ completions will be sent to the Co-Facilitator.
3.1.8 Security protocols:
3.1.8.1 The recording and the presentation will be published on the dedicated PTCMA Portal that is password-protected for access by Full Registrants on the PTCMA Portal who wish to revisit the information or wish to obtain CPD accreditation.
3.1.8.2 Presentations will be made available in a secured PDF format.
3.1.8.3 The PTCMA Portal is protected against unauthorised access. Standard precautions are taken in relation to malware, hacking and other security breaches.

3.2 Vouchers (for extending access to the recording):

3.2.1 The Recording of a V_CPD event is accessible only to PTCMA members and other Full Registrants on the PTCMA Portal.
3.2.2 To make the recording available to others, the co-facilitator can purchase vouchers to distribute as desired.
3.2.3 When accessing the recording, non-members/non-Portal Registrants will receive a pop-up requesting a code before they can view the video.
3.2.4 The recording fee, where there is also an MCQ, will include a voucher allowing 50 (fifty) individuals to access the recording. This means that the same voucher with the same code can be distributed to 50 individuals. Each individual will only be able to use the code once.
3.2.5 Additional access vouchers can be purchased.
3.2.6 A voucher with the Co-Facilitator’s branding will be provided in PDF format.
3.2.7 Distribution of the voucher is the Co-Facilitator’s responsibility.

4. Process:

4.1 The Co-Facilitator selects dates for V_CPDs from pre-determined options via the online booking form (additional dates for Corporate Members will be circulated once available).
4.2 The PTCMA will send an online V_CPD Action Form to the co-facilitator as acceptance of the V_CPD.
4.3 Should there be concerns about the topic, this will be raised before continuing with the process.
4.4 CPD points will be applied for by the PTCMA prior to the meeting through the South African Medical Association (SAMA).
4.5 The PTCMA will circulate the event details through the monthly PTCMA events update, and invitations will be distributed by email to all Full Registrants on the Portal, except those who have opted out from specific communications.
4.6 The PTCMA will monitor registrations and approve only individuals as per the PTCMA requirements.
4.7 The PTCMA will connect with the Presenter regarding preparation for the meeting and set up a test should it be necessary.
4.8 The V_CPD event shall be facilitated by the PTCMA, and the Co-Facilitator will be acknowledged during the presentation.
4.9 The co-facilitator will receive an attendance register after the event listing the names, companies and occupations of the attendees, but not contact details.
4.10 The PTCMA will generate CPD certificates for the attendees, and share the attendance register with the HPCSA as per its requirements for the generation of CPD point allocations.

5. Meeting programme:

5.1 Presenter to login to the meeting at least 20 minutes prior to scheduled start of meeting to test sound and presentation.
5.2 Participants will be admitted to the meeting 5 minutes prior to start.
5.3 The PTCMA technical representative will do a sound check and state the technical arrangements for the meeting 2 minutes prior to scheduled start.
5.4 The presenter will be introduced at the scheduled start of the meeting by the PTCMA chairperson or, if requested and agreed upon, a representative from the Co-Facilitator.
5.5 The presentation should be at least 50 minutes to comply with the CPD requirements and to allow for questions at the end of the meeting.
5.6 The meeting will be closed at not later than 60 minutes after the start.

6. Timelines:

6.1 Dates will be circulated upon renewal for the following membership period with the link to the online booking form.
6.2 The link to the V_CPD Online Action Form will be sent fourteen (14) weeks prior to the event date.
6.3 The V_CPD Online Action Form and signed Sponsorship Agreement is to be submitted to the PTCMA at least ten (10) weeks prior to the event date.
6.4 The V_CPD invitation to be circulated by the PTCMA within four (4) weeks prior to event date.
6.5 The presentation slide deck and/or other visual aids should be shared via email with the PTCMA at least five (5) days prior to the event date for compliance review.
6.6 An email reminder/ SMS to be sent by the PTCMA one (1) day before event date.
6.7 Attendance register and recording will be sent to the co-facilitator within two (2) workdays after the event.
6.8 Attendance will be recorded on the PTCMA Portal within seven (7) days of the event. CPD certificates are generated automatically upon confirmation of attendance.
6.9 Attendance lists will be sent to the HPCSA for CPD point upload at the end of each month.
6.10 MCQs compiled and uploaded to the Portal with the recording within four (4) weeks after the event.

7. Security:

7.1 The PTCMA makes use of the paid service from Zoom with advanced security features (click here for more information).
7.2 The PTCMA enforces encryption by default and make sure it is end-to-end if possible.
7.3 All delegates need to register for the meetings and are manually approved by the PTCMA host before receiving a link to join the meeting.
7.4 The link to join is set so that each registrant can only log in using one device – so links cannot be shared.
7.5 All meetings are password protected.
7.6 Access will not be granted to “dial-in” participants.
7.7 The PTCMA monitors the file and screen-sharing capabilities to ensure no sensitive information is disclosed or used to spread malicious programs.
7.8 For those participants concerned about security, the option to join from the browser is enabled.

8. Fees:
8.1 Facilitation fee per one-hour session: R9 800.00 (excl. VAT).
8.2 Option to extend the session duration: R2 300.00 (excl. VAT) per additional ½ hour.
8.3 Option to record the V_CPD, approval will be required from the presenter:
8.3.1 Recording only for an additional R2 200.00 (excl. VAT) per hour
8.3.2 Recording with MCQs for CPD accreditation for additional R4 700.00 (excl. VAT) per hour.
8.4 Option for invitation design for guests: R1 600.00 (excl. VAT).

9. Cancellation policy:
In order to protect the income and reputation of the PTCMA against untimely cancellations, this Cancellation Policy applies to all sponsored PTCMA Continuing Professional Development events:
9.1 The Sponsor will be liable for the following fees upon cancellation or postponement of a PTCMA Continuing Professional Development event:
9.1.1 If an event is postponed or cancelled within two (2) business days or less prior to the scheduled event, a cancellation fee of 100% of the facilitation fee, to cover the loss of income and administration involved in informing the registered attendees;
9.1.2 If an event is cancelled between six (6) weeks and two (2) business days prior to the scheduled date, 50% of the facilitation fee will be charged;
9.1.3 If an event is postponed once, and a new date is scheduled within the same calendar year, no cancellation fees will apply, unless clause 9.1.1 applies;
9.1.4 If an event is postponed once, and a new date is scheduled beyond the same calendar year, this will be considered a cancellation and the postponed date will constitute a new booking. In this circumstance, cancellation fees will be charged for the original booking as per clauses 9.1.1 or 9.1.2., whichever is applicable in the circumstance;
9.1.5 If an event is postponed a second time, regardless of how long in advance, this will be considered a cancellation and the postponed date will be considered a new booking. In this circumstance, cancellation fees will be charged for the original booking as per clauses 9.1.1 or 9.1.2 above, whichever is applicable in the circumstance.
9.2 The PTCMA reserves the right to use its discretion in the application of this Cancellation Policy in the event of extreme, unforeseen and uncontrollable circumstances, in which cancellation fees may be waived in part or in full.
9.2.1 It should be categorically noted that no such discretion will apply in the event of incomplete standard internal processes or contracts by the Sponsor;
9.2.2 The PTCMA respectfully requests that the Sponsor ensures that all its relevant internal processes are completed before the event invitation is distributed. Should this not be in place by a week before the scheduled event, the PTCMA reserves the right to postpone or cancel the event.

10. Patient Advocacy Groups:
Inclusion of representatives from Patient Advocacy groups is allowed as per the following terms:
10.1 Inclusion of representatives from Patient Advocacy groups is allowed as per the following terms:
10.1.1 An additional half hour needs to be added to the session. This is to ensure there is enough time for the clinical presentation, the report from the Patient Advocate and sufficient time for questions for both.
10.1.2 The Co-Facilitator takes responsibility for communicating the nature of this platform to the Patient Advocate, that no product marketing is to take place, that no negative statements will be made against any Medical Aid or other company or doctor by name.
10.1.3 Should the Patient Advocate wish to remain anonymous, his/her video will remain disabled and their screen name will simply state “Patient Advocate”.
10.1.4 Should the meeting be recorded, it should be specified whether the Patient Advocate also gives permission for their section to be recorded. Otherwise, the recording will be ended after the Q&A with the presenter.

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PLEASE NOTE THAT THIS IS JUST AN EXAMPLE AND THAT NO ACTION WILL BE TAKEN FROM THE SUBMISSION OF THIS FORM.

Scheduled Events

Please note that dates, topics and presenters are subject to change.

Jul 21

08:30 - 10:00

Virtual CPD – 21 July 2026

Jul 28

08:30 - 10:00

Virtual CPD – 28 July 2026

Jul 29

18:30 - 20:00

Evening Virtual CPD – 29 July 2026

View Calendar

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PHARMACEUTICAL & TECHNOLOGY CLINICAL MANAGEMENT ASSOCIATION

SAMPLE V_CPD Action Form

Action Form - DUMMY FORM

Event Details

Add-ons

Co-Facilitator Details

Presenter Details

Second Presenter Details

Third Presenter Details

Invoicing Requirements

Sponsoring breakdown

Scheduled Events

Latest Newsletter

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