East Coast CORE Presentation Proposal
Please complete the form below if you are interested in presenting at an upcoming meeting. PLEASE NOTE: East Coast CORE requires that all presenters be employed by a healthcare provider organization currently using Epic applications. No vendor employees or consultants are allowed.
Name:
*
First Name
Last Name
E-mail Address:
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What type of session are you interested in?
Breakout Session (45 minutes)
Vignette Session (10-15 minutes)
Presentation Title:
*
Indicate which topic your presentation will focus on:
*
HB
PB
Access
Other
Session Description:
*
Session Leader(s):
*
I will be presenting on this topic by myself.
I will be presenting on this topic with one other colleague.
Presenter #1:
*
First Name
Last Name
Email:
*
example@example.com
Organization:
*
Phone Number
*
Please enter a valid phone number.
Presenter #2:
First Name
Last Name
Email:
example@example.com
Organization:
Phone Number
Please enter a valid phone number.
Submit Form
Should be Empty: