CAP-ACP 2019 Annual Meeting - Speaker Information Form Question Title * 1. Session Title Question Title * 2. Speaker (enter position and organization as you would like them listed in the program) Name Position Organization Email Phone Question Title * 3. Audio-Visual Equipment A computer and data projector will be provided. Please specify any additional equipment required, including use of digital slides and polling. Question Title * 4. Educational Objectives: Please list 3 or more. The objectives should be written from the perspective of the learner, descriptive of what the learner will gain in knowledge, skills and attitudes as a result of participating in the event; and written to enable evaluation of achievement by the planners and participants. Please use verbs that denote an observable action, such as “list, explain, summarize, discuss, compare, etc.” NOTE: It is no longer permitted to use words that indicate emotions or feelings such as “know, learn, appreciate, understand, recognize, etc.” For a list of actionable words, please reference the "Speaker Information" page on the Annual Meeting website. At the end of the session, the participants will be able to: 1 2 3 4 5 6 Question Title * 5. Description: Please provide a summary of your presentation. At the end of your summary please indicate your target audience, for example, “The session will be of value to: pathology residents, PAs, general and anatomic pathologists.” Question Title * 6. Biography: Please provide a short bio (1-2 paragraphs) Question Title * 7. Speaker Photo - for promotional use Photo for use on course website and promotional materials DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Photo for use on course website and promotional materials Question Title * 8. Do you give permission to share session material (in pdf) of meeting mobile app? Please note only those attending meeting will have access to app material. Yes No Comment Question Title * 9. Speaker Signature and Date: I, the undersigned, the author of this presentation, certify that I have obtained all customary and necessary permission to use and print any copyright material that appears in my presentation.I agree that the Canadian Association of Pathologists may make my presentation available to individuals who may be interested in accessing it by posting it on their national association website. Speaker Name Date Done