The Forum for Healthcare Strategists. Hospital & Physician Relations: An Executive Summit. Leveraging Technology. Physician Strategies Summit.

2010 Physician Strategies Summit
Application to Present
Primary Contact Information
(All correspondence will be sent to the primary contact)
Name:
Title:
Organization:
Address 1:
Address 2:
City:
State, Zip:
Phone Number:
Fax Number:
Email Address:
 
Co-presenters (If applicable)
Name:
Title:
Organization:
Address 1:
Address 2:
City:
State, Zip:
Phone Number:
Fax Number:
Email Address:
Name:
Title:
Organization:
Address 1:
Address 2:
City:
State, Zip:
Phone Number:
Fax Number:
Email Address:
 
Presentation Information
Presentation Format: (Please check one)
  Strategy Session - a focused presentation on a cutting-edge strategy
  Case Study - a project report with detailed background information and measured results
  Panel Discussion - interactive discussion on a hot topic with 3-4 panelists
  Pre-Conference Workshop - full or half-day focused seminar for 40-70 attendees
 
Presentation Length: (Please check one)
  75 Minutes
  Half-day (2.5 hours)
  Full day (6.5 hours - pre-conf. workshop only)
 
Presentation Track/Category: (Please check the most applicable category)
  Collaboration/Competition
  Sales
  New Partnership Models
  Physician Relations
  Strategic Issues
 
Session Information
Session Title:

 
50-75 word abstract of presentation:

 
3-5 learning objectives:

 
Description of your employer organization(s):

 
Biographical briefs (one) for all presenters:
 
Handouts
All presenters are required to provide electronic handouts no later than than January 29, 2010. Meeting this deadline date is essential in order to put the handouts on the flash drive given to attendees, as well as to get CME's.
 
Waived Conference Fee
Faculty will receive a waived conference fee for the regular conference. All other expenses are the responsibility of the individual.
 
IMPORTANT:
Have you given, or will you be giving, this presentation at another educational conference?
  Yes      No    If yes, where and when?
 
Affirmation of Commitment
(Electronic Signature of primary contact required)
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 and distribute the presentation and handouts, for profit or otherwise.
 
Please enter your name below to acknowledge your agreement with the above.
Signature:
 
  
 
If you have questions, please call 312-440-9080, ext. 24.