Expert Panel Presentation Submission Form for the 2008 PAEA Education Sessions at the AAPA Annual Meeting

Please complete and submit this form by Wednesday, January 16, 2008.

* Title of Expert Panel Presentation:

Panel Presenters/Facilitator(s) minimum of 3, maximum of 5 (must include academic and professional credentials and complete contact information. Each presenter must also include statement as to why he/she is an expert in proposed topic of presentation)

Presenter 1

Expert qualification credentials and statement:

Presenter 2

Expert qualification credentials and statement:

Presenter 3

Expert qualification credentials and statement:

Presenter 4

Expert qualification credentials and statement:

Presenter 5

Expert qualification credentials and statement:

Primary contact (person to receive confirmation of material):

* Last Name

* First Name

* Credentials

* Institution

* Address

Address 2

* City

* State

* Zip Code

* Phone

* E-mail

* Educational goals and objectives (These should take the following format: "At the conclusion of this session, participants will be able to...")

* Description of session (must follow format, including a timeline of activities)

* References: (a maximum of the 5 major references only)

Time Allotment is 45 minutes

Presentation rooms will be equipped with:
* IBM-compatible laptop computer with Microsoft XP including PowerPoint and software/hardware to accept presentation on USB drive or on a CD
* LCD data projector and screen
* Microphone(s)
* One flip chart

Please indicate if other AV equipment or supplies are required (Additional equipment supplied pending approval by PAEA).

* Indicates Response Required

FormSite.com

Powered by FormSite.com