First and Last Name

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* First and Last Name

Credentials (if applicable)

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* Credentials (if applicable)

E-mail Address

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* E-mail Address

Phone Number

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* Phone Number

Three to Five Learning Objectives for This Presentation

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* Three to Five Learning Objectives for This Presentation

One to Four Suggested CDR Learning Needs Codes and One to Four Performance Indicators

Question Title

* One to Four Suggested CDR Learning Needs Codes and One to Four Performance Indicators

Would you prefer to deliver a 60 or 90 minute presentation?

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* Would you prefer to deliver a 60 or 90 minute presentation?

Applicable Website URLs and/or Social Media Handles, etc.

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* Applicable Website URLs and/or Social Media Handles, etc.

Primary Abstract Submission Upload

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* Primary Abstract Submission Upload

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen
Additional Abstract Submission Upload (if applicable)

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* Additional Abstract Submission Upload (if applicable)

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen
Presenter Resume/CV Upload

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* Presenter Resume/CV Upload

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen

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