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* 1. Enter your FULL NAME.

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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)
Half-day Workshop (3 hrs)
Full-day Workshop (6 hrs)

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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. FULL OR HALF-DAY WORKSHOPS (ONLY):  Please upload a detailed abstract or outline of your planned workshop so that the committee has more information to review when evaluating a submission for a 3- or 6-hour workshop.

PDF, DOCX, DOC file types only.
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* 16. DESCRIPTIVE PARAGRAPH:  In 3-4 sentences, provide a brief descriptive paragraph of what your presentation will cover. (This will be listed on the website and in the brochure)

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* 17. Please upload your headshot for the brochure

JPEG, JPG, PNG file types only.
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* 18. Enter your 75-word brief biography for introduction at the conference. It will also be linked in the conference app for attendee review.

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* 19. If you have any questions, please list them below and we will contact/respond immediately.

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