June 17-19, 2025, Jacksonville, Florida

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* 1. FULL NAME:  Please provide us with your full name. Note: If you have a co-presenter, there will be an opportunity to provide your co-presenter's information later in the survey.

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* 2. EMAIL:  Please provide us with an email to communicate with you about your presentation.

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* 3. Your TITLE or JOB POSITION.

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* 4. EMPLOYER, INSTITUTION, HOSPITAL or COMPANY.

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* 5. Your CITY and STATE.

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* 6. TYPE of Institution/Company?

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* 7. Number of years as a Physician Liaison. Enter '0' if not applicable.

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* 8. PRESENTATION TYPE:  Please indicate your desired presentation type.

  Preferred Will Consider
Opening Keynote
Closing Keynote
Plenary (full audience)
Breakout (simultaneous sessions for targeted groups)

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* 9. INTEREST CATEGORY: Please indicate the interest category that best aligns with your presentation submission.

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* 10. TITLE OF YOUR PRESENTATION.

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* 11. Please enter talk OBJECTIVE 1 (out of 3) below.  What can the attendee expect to learn from your presentation?

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* 12. Please enter talk OBJECTIVE 2 (out of 3) below.

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* 13. Please enter talk OBJECTIVE 3 (out of 3) below.

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* 14. Intended Audience

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* 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)

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* 16. Please upload your headshot for the website and conference mobile app

PNG, JPG, JPEG file types only.
Choose File

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* 17. Enter your 75 word brief biography for agenda link.

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* 18. Do you have a co-presenter?

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