2019 Banff Course Speaker Information Form Question Title * 1. Session Title Question Title * 2. Speaker (enter position and organization as you would like them listed in the program) Name Position Organization Email Phone Question Title * 3. Audio-Visual Equipment A computer and data projector will be provided. Please specify any additional equipment required: Question Title * 4. Educational Objectives: Please list 3 or more. The objectives should be written from the perspective of the learner, descriptive of what the learner will gain in knowledge, skills and attitudes as a result of participating in the event; and written to enable evaluation of achievement by the planners and participants. Please use verbs that denote an observable action, such as “list, explain, summarize, discuss, compare, etc.” NOTE: It is no longer permitted to use words that indicate emotions or feelings such as “know, learn, appreciate, understand, recognize, etc.” For a list of actionable words, please reference this link. At the end of the session, the participants will be able to: 1 2 3 4 5 6 Question Title * 5. Description: Please provide a summary of your presentation. At the end of your summary please indicate your target audience, for example, “The session will be of value to: pathology residents, PAs, general and anatomic pathologists.” Question Title * 6. Biography: Please provide a short bio (1-2 paragraphs) Question Title * 7. Speaker Photo Please upload photo for use on promotional materials (website etc.) DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload photo for use on promotional materials (website etc.) Question Title * 8. Speaker Signature and Date: I, the undersigned, the author of this presentation, certify that I have obtained all customary and necessary permission to use and print any copyright material that appears in my presentation.I agree that the Banff Pathology Course may make my presentation available to individuals who may be interested in accessing it by posting it on their national association website. Speaker Name Date Done