2016 Summit to Sound Speaker Information Form


Please complete the information below as you would like it printed in our promotional materials.
Name:*
Institution/Hospital/Company:
Professional Title:

Contact Information

Mailing Address:
Phone:
-
Cell:*
-
E-mail:*
Title of Presentation:*

Presentation Learning Objective Statements

Session #1: At the conclusion of this presentation attendees will be able to

Objective 1:*
Objective 2:
Objective 3:

Compensation

The WA-ACEP agrees to provide faculty with complimentary meeting registration and parking.

Audio/Visual

We ask that you bring your presentation on a flash drive. For your presentation, WA-ACEP will provide a podium, microphone, screen, LCD Projector, and laptop computer.

Laptop:
Other A/V Requests:

Syllabus Materials

All speakers are required to provide contributions for the CME E-Syllabus. Please submit your contributions no later than March 31, 2016. Email to plp@wsma.org or send large files to Dropbox.

Brief Bio Sketch:
QuestionsContact Pauline Proulx at 206-956-3648 or send an email to plp@wsma.org

Please complete this form by Feb. 1, 2016

Email: plp@wsma.org