2014 Association for Community Health Improvement National Conference 
Poster Proposal – Submission Form

Thank you for submitting a poster proposal for the 2014 ACHI National Conference in Orlando, Florida. Before submitting your proposal, please make sure that you have read the conference description and submission guidelines.

Proposals that are incomplete or do not follow the submission guidelines will not be considered for selection. If you have any difficulties or questions, please contact Julia Resnick at jresnick@aha.org or 312-422-2610.

Submission Deadline: Friday, September 20, 2013, 7:00 p.m. CT.
Lead Presenter Information:
1. First Name:
2. Last Name:
3. Credentials (degrees, certifications, etc.):
4. Job Title:
5. Organization:
6. Website:
7. City:
8. State:
9. Zip code:
10. Telephone:
11. Email:
Please submit the name, title and organization of any additional presenters or authors.
12. Presenter 2:
13. Presenter 3:
14. Presenter 4:
15. Presenter 5:
16. Are you a member of ACHI? (Note: ACHI membership is not required to present.)
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