Presenter(s):

Lead Presenter: (required)



Job/Position Title: (required)

Office/Department: (required)

Name of Institution/Organization: (required)

Are you a Vendor?
YesNo

Address (Business or Personal): (required)





Email: (required)

Phone


How many Co-Presenters do you have?

Co-Presenter


Job/Position Title: (required)

Office/Department: (required)

Name of Institution/Organization: (required)
Co-Presenter 1


Job/Position Title: (required)

Office/Department: (required)

Name of Institution/Organization: (required)


Co-Presenter 2


Job/Position Title: (required)

Office/Department: (required)

Name of Institution/Organization: (required)

Do you have additional presenters?
NoYes

Presentation Information:

Topic Focus: (Select One, required)

Title: (75 Charecters or Less, required)

Summary: In 150 words or less, please provide a description of your 50 minute presentation. If accepted, this will be used in the conference brochure. (required)

Audience Take-Aways/Learning Outcomes: In 50 words or less, describe 2-5 learning outcomes that the audience will take away from your session. (required)

Additional Comments: Use this space to provide any additional information ACTP may need to know to select or support your presentation.