1.Name (Primary Contact/Speaker)

2.Title and Organization (Primary Contact/Speaker)

3.Email (Primary Contact/Speaker)

4.Phone number (Primary Contact/Speaker)

5.List the name and email addresses of any additional speakers on the session. You may have a maximum of 3 additional speakers on your session (total of 4 speakers)

6.Proposed Session Title

7.Summary/abstract (300 words or less)

8.Session Type

30 minute platform presentation

60 minute platform presentation or panel discussion

90 minute platform presentation or panel discussion

10 minute lightening session

Other (please specify)

9.Session Objectives (1-2 objectives for lightening), (2-3 for 30 minute), (3-4 for 60 minute), (4-6 for 90 minute)

10.Special set up or AV requests. All sessions will automatically include crescent rounds, screen/projector and speaker and audience mics available. Video streaming during a presentation may not be available.

11.Other requests or considerations