2025 VAPAA Conference Speaker Application Form
Tell Us About You
Name
*
First Name
Last Name
Credentials
VA Clinic/Hospital Name
*
Medical Specialty
*
Non-VA Email
*
VAPAA is not able to use VA.gov email addresses for communications on non-VA business.
Cell Phone Number
*
Please enter a valid phone number.
Are you a current member of VAPAA?
*
Yes
No
Unsure
Please upload a professional photo for us to use in the meeting application and for use in promotional materials about the conference.
*
Browse Files
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Choose a file
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Please upload Speaker's Resume/CV as a PDF file. This will be used to determine eligibility and will be uploaded to the VAPAA Meeting Application.
*
Browse Files
Drag and drop files here
Choose a file
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Speaker's Bio
*
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Tell Us About Your Presentation
Session Title
*
Session Description
*
If you have a co-speaker/presenter, please list their name.
If you have a co-speaker/presenter, please list their email.
Learning Objectives (please upload as 1.xxx, 2.xxx, etc)
*
Please choose your presentation slot preferences
*
1st Preference
2nd Preference
3rd Preference
Monday - Early Morning
Monday - Late Morning
Monday - Early Afternoon
Tuesday - Early Morning
Tuesday - Late Morning
Tuesday - Early Afternoon
Wednesday - Early Morning
Wednesday - Late Morning
Wednesday - Early Afternoon
Second Lecture Submission
If you have a second lecture you would like to submit, please complete this page. If you do not have a second lecture you would like to submit, please advance to the next page.
2nd Lecture Title
2nd Lecture Description
If you have a co-speaker/presenter for the second lecture submission, please list their name.
If you have a co-speaker/presenter, for the second lecture submission, please list their email.
2nd Lecture Learning Objectives (please upload as 1.xxx, 2.xxx, etc)
Please choose your presentation slot preference for your second lecture.
1st Preference
2nd Preference
3rd Preference
Monday - Early Morning
Monday - Late Morning
Monday - Early Afternoon
Tuesday - Early Morning
Tuesday - Late Morning
Tuesday - Early Afternoon
Wednesday - Early Morning
Wednesday - Late Morning
Wednesday - Early Afternoon
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Required Disclosure Information
Complete the AAPA CME Disclosure Form
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Do you intend to discuss any unapproved / investigational use of a commercial product/device?
*
No
Yes
I will provide a balanced view of therapeutic options and will be entirely free of promotional bias
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Yes
No
Please electronically sign your application.
*
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