ACDIS 2020: Poster Presentation Application Survey

1.Please provide your name, credentials, and contact information.
(Required.)

Name

Credentials

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Company/Organization

Email Address

Phone Number

2.Please indicate whether you work as a consultant or in the provider/hospital setting.
(Required.)

Provider

Consulting

Other (please specify)

3.How long have you worked in the CDI profession?(Required.)

4.Are you an ACDIS member? (You do not need to be an ACDIS member to be selected.)(Required.)

Yes

I don't know

5.Please provide a reference (name, email address, and phone number) of a colleague.

Name

Email address

Phone number

6.Please upload your headshot and professional bio (in one file, please).(Required.)

No file chosen

7.Please upload a one-page summary (description) of your poster's content.

No file chosen

8.Poster presenters must be able to travel to the ACDIS annual conference and agree to participate in dedicated discussion times during conference networking sessions. Will you be able to participate?(Required.)

Yes

Current Progress,

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