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Submitter Contact Information:

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Please list your availability to present a webinar:

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Webinar Title:

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Select Preferred Webinar Length:
--30-Minute Webinar (A narrow topic, specific issue or innovative idea, thought leader or expert interview)
--60-Minute Webinar (An in-depth discussion on a relevant topic with audience interaction, such as live or text Q&A session, panel discussion, and/or audience polls, etc.)

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Target Audience (Select all that apply):

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Practice Setting (Select all that apply):

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