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Submit a Presentation Proposal Today!

Share your expertise at the AAPA’s 37th Annual Physician Assistant Conference in San Diego, California, Saturday, May 23rd - Thursday, May 28th, 2009.

ALL PROPOSALS ARE DUE SEPTEMBER 15, 2008.

Presentation Title

Primary Speaker/Chair

Primary Therapeutic Category

Secondary Therapeutic Category

Tertiary Therapeutic Category

PA Constituent Organization Submitting

AUDIENCE SPECIALTY EXPERIENCE: (check one)

Less than 5 years in current specialty

6-10 Years in current specialty

11-20 Years in current specialty

More than 20 years in current specialty

AUDIENCE LEVEL: (check one)

General (suitable for all)

Advanced (most suitable for specialty experienced PAs)

INSTRUCTIONAL METHOD: (check one most appropriate)

LENGTH OF TIME REQUIRED:

Minimum 60 minutes (1 hour)

Minimum 90 minutes (1.5 hours)

Minimum 120 minutes (2 hours)

Minimum 150 minutes (2.5 hours)

Minimum 180 minutes (3 hours)

Minimum 210 minutes (3.5 hours)

Minimum 240 minutes (4 hours)

Other (please provide detailed explanation):

LEARNING OBJECTIVES (Complete this sentence, “At the conclusion of this presentation, participants will be able to…”):

PROGRAM DESCRIPTION (75-100 words describing session content and format. Be as specific as possible.) Descriptions are subject to editing for use in the final program. Workshop requests should include a list of ALL equipment and supplies required for a successful workshop. In addition, workshop requests must include a proposed floor plan for a successful workshop.

PROGRAM OUTLINE: A one-page outline of your presentation is required. Please attach your outline to this proposal. After using the Browse button to select your outline, click on Upload.

TELL US ABOUT YOURSELF: Have you or one of your co-presenters given this specific presentation at another conference?

Yes

No

If yes, please specify where and when?

Attach a copy of the curriculum vitae for the Primary Speaker/Chair. After using the Browse button to select the CV, click on Upload.

Primary Speaker

Name

AAPA Member Number

Title

Organization(E.G., Practice Name, Institution)

Address

City, State, Zip

Phone

Fax

E-Mail

Co-Presenter #1:

Name

AAPA Member Number

Title

Organization

Address

City, State, Zip

Phone

Fax

E-mail

Co-Presenter #2:

Name

AAPA Member Number

Title

Organization

Address

City, State, Zip

Phone

Fax

E-mail

Co-Presenter #3:

Name

AAPA Member Number

Title

Organization

Address

City, State, Zip

Phone

Fax

E-mail

Please attach a list of personal references who have seen or heard you speak. After using the Browse button to select your list of references, click on Upload.

Referring Constituent Organization:

Prior to finalization of the CME agenda, AAPA will correspond with the primary speaker only. Please list yourself as the primary speaker and list any co-presenters. Please remember that all PA speakers, panelists, workshop assistants, workshop instructors, and workshop chairs must be current members of the American Academy of Physician Assistants at the time of participation.