2011 Call for Presentations - National Association of Healthcare Access Management

Workshop Proposal Submission Form
Please complete the information below and click "submit". Only those submissions that provide all requested information will be reviewed.

Presentation Information:

Presentation Title (Please use ten words or less. Subject to editing): *

Description: Using 75 words or less, write a brief description of your suggested session. Information is subject to editing and will be printed in the registration brochure and on-site program

Please consider this proposal for a: *

I am willing for NAHAM to pair me with another presenter on a like topic. *
Yes
No

What area(s) will your presentation focus on?

What level of experience would this presentation be prepared for?

Presenter(s) Information:

Primary Presenter: *

Degrees/Credentials: *

Organization: *

Address: *

City: *

State: *

Zip: *

Telephone: *

Fax: *

Email: *

Type your biographical information as you wish for it to be presented at by the moderator of your sessoin. Enter your co-presenter's bio information in the co-presenter fields below. Not to exceed 100 words *

Co-Presenter #1

Degrees/Credentials:

Organization:

Address:

City:

State:

Zip:

Telephone:

Fax:

Email:

Type in biographical information as you wish the session moderator to introduce co-presenter #1. Not to exceed 100 words.

Co-Presenter #2

Degrees/Credentials:

Organization:

Address:

City:

State:

Zip:

Telephone:

Fax:

Email:

Type in biographical information as you wish the session moderator to introduce co-presenter #2. Not to exceed 100 words.

Co-Presenter #3:

Degrees/Credentials:

Organization:

Address:

City:

State:

Zip:

Telephone:

Fax:

Email:

Type in biographical information as you wish the session moderator to introduce co-presenter #3. Not to exceed 100 words.

Audio Visual Equipment:

Audio Visual Requests (hold control key to select multiple):

Other A/V needs (Note: NAHAM cannot provide Internet connectivity or computer equipment):

Note: We can only accommodate requests for audio visual equipment submitted on this form. No on-site equipment additions can be accommodated.

Authorization of Presentation Use:

I authorize NAHAM to consider this session to be part of the Virtual Conference; participating presentations will be recorded live and made available for On Demand viewing on the NAHAM website. *
Yes
No

I authorize NAHAM make my slides available to conference attendees through NAHAM's website prior to the conference and one month following the conference. Presentations must be submitted by March 1, 2011 to be included. *
Yes
No

Learning Objectives:
You MUST list at least two learning objectives below.

Learning Objective One. By the end of the session, learner will be able to: *

Learning Objective Two. By the end of the session, learner will be able to: *

Learning Objective Three. By the end of the session, learner will be able to: