2026 CME Speaker Application Question Title * 1. First Name, Last Name, Credentials Question Title * 2. Are you a PAFP member? Yes No Question Title * 3. Preferred Phone Number and Email Preferred Phone Number Preferred Email 2026 is a license renewal year!PA-mandated Opioid and Child Protection CME must be on file with the Department of State by the end of the year. In order to best meet the needs of our audience, priority will first be given to those applications covering these topics.I am applying for the following conferences/events (please check all that apply below.) ADDITIONAL TOPICS FOR CONSIDERATONBelow are additional suggested areas of focus most requested by our members. While encouraged to submit on the below topic areas, others outside of these suggestions will certainly be considered, provided they are germane to primary care. You will be asked for a session title and learner objectives within this application. Behavioral/Mental Health Cardiology Dermatology Endocrinology Gastroenterology Geriatrics Hospice/End of Life Care Hospital Medicine Infectious Disease Lifestyle Medicine/Wellness and Wellbeing Men's Health Neurology Oncology Orthopedics/Procedures Pediatrics Practice Management, i.e. Billing, Coding, Administrative Burden, etc. Sleep Medicine Sports Medicine/Musculoskeletal Technology / AI in Medicine Women’s Health Question Title * 4. SPRING AND SUMMER CMEI am applying for the following conferences/events (please check all that apply) Spring FM Essentials CME Summit – April 4, 2026, Bethlehem, PA Application Submission Deadline December 15, 2025 Summer SEA-M-E Conference – June 7 - 11, 2026, Dewey Beach, DE Application Submission Deadline January 15, 2026 The Fall 2026 Summits will consist of three 1/2-day sessions focusing solely on Opioid/Pain Management and Child Protection CME. If you would like to apply for one of these, please do so below. The exact locations will be listed after August 20. Question Title * 5. Fall Options: Fall CME Family Medicine Essentials October 3, 2026, in the Valley Forge area.Application Submission Deadline June 15, 2026 Fall CME Family Medicine Essentials October 10, 2026, in the Harrisburg/Lancaster area. Application Submission Deadline June 15, 2026 Fall CME Family Medicine Essentials October 31, 2026, in the Pittsburg area. Application Submission Deadline June 15, 2026 PRESENTATION TYPES Didactic Presentation time needed including Q & A: 30 mins - 60 mins Procedures Workshop Up to 2 hours maximum of hands-on procedures (Summer Conference Only) Panel Discussion Round Table Case Studies Interactive Lecture YOUR SPECIFIC SESSION (S)Please use the space below to enter the information about the specific session(s) you would like to present at a PAFP CME Conference.Include: The topic, be as specific as possible - see above Practice Gaps - What is the practice-based problem you are addressing? Learner Objectives Presentation type - see above Complexity levelBeginner is learning the fundamentals with some familiarity.Intermediate is applying new knowledge to build foundation of experience.Advanced is extensive competency of complex concepts. Question Title * 6. Will you have a co-presenter? Yes No Question Title * 7. If yes, please include their name and credentials and a contact email. Co-Presenter Name, Credentials and Affiliation Co-Presenter Email Co-Presenter Name, Credentials and Affiliation Co-Presenter Email Question Title * 8. Session #1 Topic (please be specific) What knowledge or skill will be taught? Practice Gap Learner Objective #1 Learner Objective #2 Learner Objective #3 Presentation Type (Didactic, Workshop, etc.) Complexity Level (Beginner, Intermediate, Advanced) Exact amount of time needed for this session? (see parameters above) Question Title * 9. Session #2 (if applicable) Topic (please be specific) What knowledge or skill will be taught? Practice Gap Learner Objective #1 Learner Objective #2 Learner Objective #3 Type of Presentation (Didactic, Workshop, etc.) Complexity Level (Beginner, Intermediate, Advanced) Exact amount of time needed for this session? (see parameters above) Question Title * 10. Session #3 (if applicable) Topic (please be specific) What knowledge or skill will be taught? Practice Gap Learner Objective #1 Learner Objective #2 Learner Objective #3 Type of Presentation (Didactic, Workshop, etc.) Complexity Level (Beginner, Intermediate, Advanced) Exact amount of time needed for this session? (see parameters above) SPEAKING EXPERIENCEPlease use the space below to enter the information about previous speaking experience, topics, audience. Question Title * 11. Have you spoken at a previous PAFP CME Conference? Yes No Question Title * 12. Please list three of your most recent speaking engagements not for PAFP Note: If you have spoken at a PAFP Conference (see question above) in the last 5 years we will look up the information. #1 Name of Conference/or Event Location Date Topic (please be specific) Who was the audience? #2 Name of Conference/or Event Location Date Topic (please be specific) Who was the audience? #3 Name of Conference/or Event Location Date Topic (please be specific) Who was the audience? Question Title * 13. Please list two references in regards to your speaking experience. #1 Name of Reference Reference Organization Reference Phone Number Reference Email #2 Name of Reference Reference Organization Reference Phone Number Reference Email Question Title * 14. UPLOAD EVALUATION SCORES Please include your evaluation scores. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File UPLOAD EVALUATION SCORES Please include your evaluation scores. Question Title * 15. UPLOAD A BRIEF BIO HEREPlease include you a brief bio that can be used to introduce you. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File UPLOAD A BRIEF BIO HEREPlease include you a brief bio that can be used to introduce you. APPLICATION REVIEW PROCESSApplications are reviewed as they are received from PAFP and can be submitted any time before the deadline. Applications submitted after the deadline may be accepted if there is an opening on the event agenda. Upon approval of your application, you will be notified confirming your participation and specifics. Thank you for applying to present at a PAFP CME Conference. Done
