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* 1. Application Submitted By:
This person will be contacted by AHCA with any questions regarding the submission and will be sent notification once session selections are finalized.

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* 2. Events you would like your proposal to be considered for?  (You may select more than one event)

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* 3. Topic Areas:
Please select only one topic area. Choose the one that best fits your session.  Use "other" option if you fee your session cannot be appropriately fit under any of the provided topics. Please note that up to 3 separate proposals may be submitted for consideration

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* 4. Session Title: the title should reflect the purpose of the session and be limited to 10 words or less

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* 5. Summary:
Please provide a brief description of your session in 75 words or less, to be used in the brochure that participants reference when choosing which sessions to attend.

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* 6. Please include 3 Learning Objectives for your session.

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* 7. Can your presentation be done in a webinar format?

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* 8. Presenter Information:
Presenter contact information

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* 9. Presenter Biography: Please provide a biological sketch of 75 words or less, highlighting accomplishments, experience and relevant knowledge of the speaker.  this information is used to evaluate the qualifications of the speaker as it pertains to the subject matter of his or her proposal. This information may also be used for speaker introductions and marketing of the session and should be written in third-person. A resume may be submitted also but does not replace the biographical sketch.

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* 10. Will you require a speaker fee/honorarium? (Note: Answering this quetion will not disqualify you as a presenter, this is strictly for budgetary purposes)

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* 11. If you answered "yes" to Question 13., please enter the anticipated fee(s)

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