2019 OPAT Presenter Application Applicant Information Question Title * 1. Have you reviewed the conference overview, essential information and selection criteria? Yes No Question Title * 2. Main Contact Name (First and Last) Question Title * 3. Organization Question Title * 4. Title or role in your organization Question Title * 5. Email Question Title * 6. Phone Question Title * 7. Format of Presentation 45 minute Oral Presentation 90 minute Oral Presentation Poster Presentation Question Title * 8. Please list ALL presenters with their names, organizations, titles/roles, credentials, email addresses and phone numbers. Note: if you have more than 2 presenters you will need to include them in the following question along with a compelling reason why more than 2 presenters is integral to your presentation. Presenter 1 Presenter 2 Question Title * 9. Do you have more than 2 presenters? Yes No Next