2024 MPCA Annual Conference Speaker Proposal Form
Speaker's Name
*
First Name
Last Name
Job Title
*
Company / Organization
*
Degree
Company / Organization Website
*
City
*
State
*
Speaker Phone
*
Speaker E-mail
*
example@example.com
Secondary Contact / Assistant Phone
Secondary Contact / Assistant Email
-
Bio for Speaker
*
Are you also planning to be an Exhibitor at the Annual Conference?
*
Please Select
Yes
No
Do you have a speaker's fee or honorarium?
*
Please Select
Yes
No
In addition to covering travel and lodging expenses for conference speakers, we want to ensure that speakers are fairly compensated for their work.
Session Information
Title of Session:
*
Abstract. Your session abstract should provide a clear and concise summary of your presentation’s content.
*
Key Objectives. Please list at least three learning objectives for your session. These are required for CME accreditation.
*
Target Audience
*
If Other, please describe the Target Audience for your presentation.
Have you given this presentation before and/or do you intend to present it elsewhere in the near future?
*
Please Select
Yes
No
If YES, please list when and where.
I understand that my presentation would be available on the conference website for attendees to download after the event.
*
Please Select
Yes
No
Signature
Submit
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