DistanCE Webinar Submission Question Title * Presenter Name(s) & Affiliation(s) Question Title * Webinar Title Question Title * Webinar Topic Question Title * Course Description (150 words or less) Question Title * 3-4 Learning Objectives Learning Objective 1 Learning Objective 2 Learning Objective 3 Learning Objective 4 Question Title * Description of Target Audience Question Title * Instructional Level of Presentation Introductory Intermediate Advanced Question Title * Please select desired webinar length 60 minutes 90 minutes 120 minutes Question Title * Please select webinar format Live Webinar Live Panel Webinar Live Point-Counterpoint Webinar Other (please specify) Question Title * Please submit a short speaker bio for promotional use Question Title * Please upload speaker CV PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Please upload speaker CV Question Title * Please upload speaker CV PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Please upload speaker CV Question Title * Please upload speaker CV PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Please upload speaker CV Question Title * Please upload a speaker photo for promotional use PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Please upload a speaker photo for promotional use Question Title * Please upload a speaker photo for promotional use PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Please upload a speaker photo for promotional use Question Title * Please upload a speaker photo for promotional use PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Please upload a speaker photo for promotional use Question Title * Please upload a document with 8-10 multiple choice questions/answers for use with the recorded version of the webinar for homestudy CE credits PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Please upload a document with 8-10 multiple choice questions/answers for use with the recorded version of the webinar for homestudy CE credits Submit
