Spotlight 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 Spotlight Presentation:

* Author(s)/Facilitator(s) maximum of 2 (include academic and professional credentials and preferred e-mail address)

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 presentation (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