* 1. Name of Lead Presenter and Co-Presenters (if known):

* 2. Contact Information of Lead Presenter: Address & Phone

* 3. Email of Lead Presenter:

* 4. Workshop Title:

* 5. Workshop Description (250 words max)

* 6. List 3 behaviorally oriented objectives:
(Objectives should describe what the learner will be able to do at the end of the workshop discussion. Examples of behaviorally oriented verbs include "state", "describe", "identify", "recall", "define", determine", etc.)

* 7. Briefly describe your intended audience for your workshop (limit 75 words)

* 8. Please provide a brief outline of your workshop with approximate times for each topic. Include a brief description of how your workshop will allow for audience interaction and in which sections.

* 9. Briefly describe the features of your workshop that are innovative. (limit 75 words)

* 10. I understand the terms and conditions of submitting a workshop proposal for the 2013 Academy of Breastfeeding Medicine Meeting.

All workshops will occur simultaneously, so no one person should plan to present at more than one workshop.

• ABM does not waive registration fees or reimburse expenses for workshop presenters.
• A computer and LCD projector may be available onsite if needed.
• Shipping of special equipment for workshops is the responsibility of the presenters.
• Copies of handouts and visual aids are the responsibility of the presenters to bring to the workshop.
• Presenters will abide by dates for submission of workshop materials for CME review in a timely fashion.
• All presenters must submit a disclosure of conflict of interest statement for the purposes of continuing medical education accreditation prior to the meeting.