Primary Contact Information
(All correspondence will be sent to the primary contact)
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Name:
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Title:
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Organization:
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Address 1:
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Address 2:
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City:
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State, Zip:
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Phone Number:
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Fax Number:
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Email Address:
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Co-presenter (If applicable)
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Name:
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Title:
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Organization:
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Address 1:
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Address 2:
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City:
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State, Zip:
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Phone Number:
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Fax Number:
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Email Address:
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Presentation Information
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Presentation Format: (Please check one)
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Presentation Length:
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All sessions are 60 minutes in length
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Presentation Categories: (Please check the most applicable category)
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Session Information
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Session Title:
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50-75 word abstract of presentation:
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3-5 learning objectives:
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Description of your employer organization(s):
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Biographical briefs (one) for all presenters:
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Handouts
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All presenters are required to provide electronic handouts.
The Conference Sponsors will make photocopies of all presentation handouts
submitted by September 26, 2008. After September 26th, presenters are
responsible for making photocopies for all conference attendees.
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Waived Conference Fee
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Faculty will receive a waived conference fee for the regular conference.
All other expenses are the responsibility of the individual.
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IMPORTANT:
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Have you given, or will you be giving, this presentation at another educational conference?
Yes
No
If yes, where and when?
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Affirmation of Commitment
(Electronic Signature of primary contact required)
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If the proposal is accepted, I agree on behalf of myself
and all co-presenters to meet all deadlines established by
the Conference Sponsors. I agree not to change content or
presenters without the express written consent of the
sponsors. I understand that I am responsible for all costs
of the presentation, including travel, hotel and per diem. I
grant the Conference Sponsors the right to audiotape,
distribute, and/or post online the presentation and handouts,
for profit or otherwise.
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Please enter your name below to acknowledge your agreement with the above.
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Signature:
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If you have questions, please call 312-440-9080, ext. 23.
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