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* 1. Presenter Information

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* 2. Are you a PDC member?

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* 3. Please provide contact information for a PDC reference:

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* 4. Program Title:

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* 5. Program Description:

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* 6. Describe at least three learning objectives:

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* 7. Please select the best category for the program. (Please note this is for planning purposes only.)

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* 8. What is one concrete tool, handout, checklist, action item, etc. that participants can take away from the session?

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* 9. Target Audience (This program is most appropriate for):

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* 10. What is the ideal program duration (please select all that apply):

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* 11. What interactive components do you plan to incorporate into your method of delivery (select no more than 3):

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* 12. Will you have a co-presenter?

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* 13. Co-Presenter #1 Information (if applicable):

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* 14. Is the Co-Presenter #1 a PDC Member?

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* 15. Co-Presenter #2 Information (if applicable):

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* 16. Is the Co-Presenter #2 a PDC Member?

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* 17. Have you or any of your co-presenters previously presented at a PDC Conference?

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