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Title (10 word limit):
Topic*
Second Topic
Other
Length of presentation only (before questions)*
This presentation complements other material submitted by
Has this material been given at other forums?
Total Number of People Presenting*
Please describe when, where and in what form:
If more than one presenter, all secondary presenter(s) information is required for continuing education approval process. No more than two presenters for the 20 minute session and no more than 3 presenters for the 50 minute session.
Primary Presenter*
Organization and Job Title*
Address*
City*
State*
Zip Code*
Phone*
Fax
E-mail*
Degree
Primary Presenter Biography (150 words or less)*

(Instructors background applicable to the course, a resume of relevant training and experience – required for CEU approval)*
*

Secondary Presenter(s) Organization and Job Title(s) Address City State Zip Code Phone E-mail Co-presenter(s) Bio(s) (150 words or less)
Briefly describe the conclusions or analysis you intend to present (150 words or less)*
Primary learning objectives for the presentation? (150 words or less)*
Abstract of Presentation (150 words or less)*
Presentation Summary for Conference Program (50 words or less)*
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Secondary Presenter(s)	Organization and Job Title(s)	Address	City	State	Zip Code	Phone	E-mail	Co-presenter(s) Bio(s) (150 words or less)