Presenter 1 (for a 75 minute Panel submission, this is the Primary presenter to be contacted with questions)
First Name:
Last Name:
Credentials:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Email:
Speaking Experience
Presenter 2
First Name:
Last Name:
Credentials:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Email:
Speaking Experience
Presenter 3
First Name:
Last Name:
Credentials:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Email:
Speaking Experience
Facilitator (Must be filled in for Panel Presentations)
First Name:
Last Name:
Credentials:
Address:
City:
State:
Zip:
Country:
Phone:
Fax:
Email:
Speaking Experience
Track
(please select track, to select multiple, press the shift button and select option
Title:
Abstract:
Description as you would like it to appear on the web and in the conference program. Please describe your session in 100 words or less (including what you will present, how, and what participants will do):
Learning Objectives
Describe how this session supports the conference theme, selected track, and what participants will learn. List 3 most important objectives, and describe the specific methods you will use. If there are multiple presenters, describe what each presenter will uniquely contribute to the session. (1 sentence per objective; 300-words maximum total)
Session Format
Session Format (If Other):
Bios of Presenter(s)
Please provide brief biographical information for the conference program about each presenter (3-5 sentences; 150 word limit).
Direct questions concerning the submission process to: presentations@cleanmed.org
THANK YOU! We will be contacting presenter applicants by February 11, 2008 to let you know if your proposal is accepted.
