AAPL 2021 Virtual Annual Conference - Presenter Submission Question Title * 1. Enter your FULL NAME. Question Title * 2. EMAIL: Please provide us with an email to communicate with you about your presentation. Question Title * 3. Your TITLE or JOB POSITION. Question Title * 4. EMPLOYER, INSTITUTION, HOSPITAL or COMPANY. Question Title * 5. Your CITY and STATE. Question Title * 6. TYPE of Institution/Company? Academic Community Children's Hospital Independent Practice/Medical Group Consultant/Consulting Firm Professional Speaker Sponsor Partner Other (please specify) Question Title * 7. Number of years as a Physician Liaison. Enter '0' if not applicable. Question Title * 8. PRESENTATION TYPE: Please indicate your desired presentation type. Preferred Will Consider Opening Keynote Opening Keynote Preferred Opening Keynote Will Consider Closing Keynote Closing Keynote Preferred Closing Keynote Will Consider Plenary (full audience) Plenary (full audience) Preferred Plenary (full audience) Will Consider Breakout (simultaneous sessions for targeted groups) Breakout (simultaneous sessions for targeted groups) Preferred Breakout (simultaneous sessions for targeted groups) Will Consider Question Title * 9. INTEREST CATEGORY: Please indicate the interest category that best aligns with your presentation submission. Physician Marketing/Physician Strategy Physician Relations & Sales Director/Leader Other (please specify) Question Title * 10. TITLE OF YOUR PRESENTATION. Question Title * 11. Please enter talk OBJECTIVE 1 (out of 3) below. What can the attendee expect to learn from your presentation? Question Title * 12. Please enter talk OBJECTIVE 2 (out of 3) below. Question Title * 13. Please enter talk OBJECTIVE 3 (out of 3) below. Question Title * 14. Intended Audience Manager/Director Experienced Liaison New Liaison Other (please specify) Question Title * 15. DESCRIPTIVE PARAGRAPH: In 3-4 sentences, provide a brief descriptive paragraph of what your presentation will cover. (This will be listed on the website and in the brochure) Question Title * 16. Please upload your headshot for use if your presentation is accepted. JPEG, JPG, PNG file types only. Choose File Choose File No file chosen Remove File Please upload your headshot for use if your presentation is accepted. Question Title * 17. Second Presenter (if applicable) Please upload your headshot for use if your presentation is accepted. PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Second Presenter (if applicable) Please upload your headshot for use if your presentation is accepted. Question Title * 18. Second Presenter (if applicable) Enter your 75-word brief professional biography. Question Title * 19. Enter your 75-word brief professional biography. Question Title * 20. If you have any questions, please list them below and we will contact/respond immediately. Done