2025 CME Speaker Application Question Title * 1. First Name, Last Name, Credentials Question Title * 2. Are you a PAFP member? Yes No Question Title * 3. Preferred Phone Number and Email Preferred Phone Number Preferred Email Question Title * 4. Have you spoken at a previous PAFP CME Conference? Yes No If yes, please list most recent. Question Title * 5. I am applying for the following conferences/events (please check all that apply) Spring CME Family Medicine Essential Conference – April 5, 2025, Lancaster, PA Application Submission Deadline December 1, 2024 Summer CME Conference – June 8-12, 2025, Dewey Beach, DE Application Submission Deadline January 15, 2025 Fall CME Family Medicine Essential Conference October 18,2025 State College, PA Application Submission Deadline June 15, 2025 None of the above, but I would like to be considered for a future Conference TOPICSBelow are the suggested areas of focus most requested by our members. Speakers are encouraged to develop a presentation focusing on one of the below, although topics outside of these suggestions will certainly be considered provided they are germane to primary care. You will be asked for a session title and learner objectives within this application. Behavioral/Mental Health Cardiology Child Protection (Act 31) Dermatology Endocrinology Gastroenterology Geriatrics Hospice/End of Life Care Hospital Medicine Infectious Disease Leadership/Career Advancement Lifestyle Medicine Men's Health Neurology Oncology Opioids/MOUD Orthopedics/Procedures Pain Management Pediatrics Physician Wellness/Wellbeing Practice Management, i.e. Billing, Coding, Staffing, Practice Efficiency, Administrative Burden, etc. Procedures: splinting, casting, MSK Sleep Medicine Sports Medicine/Musculoskeletal Technology Wellness/Wellbeing Women’s Health Other PRESENTATION TYPES Didactic Presentation with one presenter – time needed including Q & A: 30 mins - 60 mins Didactic Presentation with a co-presenter – time needed including Q & A: 30 mins - 60 mins Procedures Workshop with one presenter - Up to 2 hours maximum of hands-on procedures Procedures Workshop with a co-presenter - Up to 2 hours maximum of hands-on procedures Panel Discussion Round Table Case Studies Interactive Lecture YOUR SPECIFIC SESSION (S)Please use the space below to enter the information about the specific session(s) you would like to present at a PAFP CME Conference.Include: The topic, be as specific as possible - see above Practice Gaps - What is the practice-based problem you are addressing? Learner Objectives Presentation type - see above Complexity levelBeginner is learning the fundamentals with some familiarity.Intermediate is applying new knowledge to build foundation of experience.Advanced is extensive competency of complex concepts. Question Title * 6. Session #1 Topic (please be specific) What knowledge or skill will be taught? Practice Gap Learner Objective #1 Learner Objective #2 Learner Objective #3 Presentation Type (Didactic, Workshop, etc.) Complexity Level (Beginner, Intermediate, Advanced) Question Title * 7. Session #2 (if applicable) Topic (please be specific) What knowledge or skill will be taught? Practice Gap Learner Objective #1 Learner Objective #2 Learner Objective #3 Type of Presentation (Didactic, Workshop, etc.) Complexity Level (Beginner, Intermediate, Advanced) Question Title * 8. Session #3 (if applicable) Topic (please be specific) What knowledge or skill will be taught? Practice Gap Learner Objective #1 Learner Objective #2 Learner Objective #3 Type of Presentation (Didactic, Workshop, etc.) Complexity Level (Beginner, Intermediate, Advanced) Question Title * 9. Past ExperiencePlease upload a brief bio including previous speaking experience, topics, audience and evaluation summaries if available. PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Past ExperiencePlease upload a brief bio including previous speaking experience, topics, audience and evaluation summaries if available. APPLICATION REVIEWAL PROCESSApplications are reviewed as they are received from PAFP and can be submitted any time before the deadline. Applications submitted after the deadline may be accepted if there is an opening on the event agenda. Upon approval of your application, you will be notified confirming your participation and specifics. Thank you for applying to present at a PAFP CME Conference. Done