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NCCHC & AJA Joint Virtual Conference Call for Proposals
"One System, One Team: Aligning Care, Custody and Outcomes"
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1.
Lead speaker Information
(Required.)
Name
Email Address
Phone Number
Credentials (MD, Lt, PhD, RN, Sgt, Cpt., LCSW, etc)
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2.
Please provide a brief professional biography (100 words maximum).
(Required.)
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3.
Please upload a 1-page CV or resume.
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4.
Please describe your experience and qualifications related to this presentation topic.
(Required.)
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5.
Click on this link to review the definition of ineligible company
.
Do you have any financial relationships with an ineligible company?
(Required.)
Yes
No
6.
If yes, please identify the ineligible company/ies and describe the nature of the financial relationship
. (
owner, employee, researcher, consultant, advisor, speaker, independent contractor, royalties or patent beneficiary, executive role, and ownership interest. Individual stocks and stock options should be disclosed.)
Ineligible Company 1:
Ineligible Company 2:
Ineligible Company 3:
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7.
Will there be co-presenters?
Max of 3 presenters for a 60 minute session.
(Required.)
Yes
No
