2018 RCPA Conference
October 2 - 4, 2018
Hershey Lodge, Hershey, PA

* 1. Presentation Title:

* 2. Workshops are normally 90 minutes in length.  However you may schedule a double workshop (180 minutes) for advanced topics and ethics. Presenters must leave time for Q&A in planning for every workshop.

Please enter the length of your workshop: 90 minutes or 180 minutes.

* 3. Primary Topic Area (please indicate which of the following topic areas your presentation addresses)

* 4. Describe your proposal. Provide three measurable learning objectives for this presentation using the guidelines provided.

* 5. Description and Outline. This description assists the committee in reviewing your proposed topic. It should be clear and specific, address how you will assure the audience can achieve the learning objectives, and what attendees will take away from the workshop that will change the way they work. 

* 6. Abstract: Provide a paragraph description of your presentation in 125 words or less. This description will be used in the conference program.

Presenter Information: The below information must be provided for each presenter. You may have up to, but no more than, four presenters for a 90 minute workshop; 6 presenters for a 180 minute workshop. Please note that all correspondence from RCPA is sent to the primary presenter who is responsible for sharing it with co-presenters. At least one presenter must have a master's degree or higher.

* 7. Primary Presenter:

* 8. Second Presenter:

* 9. Third Presenter:

* 10. Fourth Presenter:

* 11. Fifth Presenter (allowed for 180 minute workshop only):

* 12. Sixth Presenter (allowed for 180 minute workshop only):

Provide the background, knowledge, and expertise of each presenter by submitting a resume/curriculum vitae for every presenter via email to Sarah EysterProposals without this information are incomplete. 

* 13. Please indicate your audio-visual needs. An LCD projector, screen, and internet connection are provided for every presentation. Other equipment as noted below may be requested and reserved. Please indicate your needs. 
Laptops are the responsibility of the presenter.

Statement of Vested Interest
Having an interest in an organization does not prevent a speaker from making a presentation but the audience must be informed of this relationship prior to the start of the activity. Each presenter should read the following statement and mark the appropriate response. Vested interest statements are required by accrediting bodies.

I recognize that I must follow all guidelines and criteria regarding vested interest. Any real or perceived conflict of interest for a conference participant must be disclosed. For this purpose a real or apparent conflict of interest is defined as having a significant financial interest in a product to be discussed directly or indirectly during the presentation, being or having been an employee of a company with such financial interest, and/or having had substantial resear support by an industry to study the product to be discussed at the presentation. A disclosure slide must accompany you PowerPoint presentation. It can use one of the following statements below. 

* 14. If you are employed by a commercial entity, it must be disclosed.

Thank you for taking the time to complete this proposal form.