Submit an Abstract

First Name*

Last Name*

Credentials

Job Title*

Organization Name*

Mailing Address*

Address Line 2

City*

State*

Zip Code*

Phone Number*

Email Address*

Abstract Title*

Select a presentation category (check all that apply)

You may leave this question blank if you do not know what category your presentation fits into.

Presentation Objectives (3 Minimum)*

Please summarize your research/presentation*

Please list an action item or a take away that our attendees can use to replicate your success in their community or ways they can support a national effort.*

Have you ever presented this before?*

YesNo

Where was this presented before?*

When was this presented before?*

What type of presentation are you interested in doing?*

Check all that apply. (Please note: we will do our best to accommodate your preference, but cannot make any guarantees).

Plenary SessionConcurrent WorkshopPoster Session

What Audio Visual capabilities do you require for your presentation?

Check all that apply.

PowerPointAudioVideoNone

Can we share your PowerPoint presentation/print materials with our conference attendees?*

YesNo

Is the Primary Presenter the same person as the Abstract Submitter?*

YesNo

Please provide the following contact information for the primary presenter below.

First Name*

Last Name*

Credentials

Job Title*

Organization Name*

Mailing Address*

City*

State*

Zip Code*

Phone Number*

Email Address*

Primary Presenter Bio*

Will this presentation have a secondary presenter?*

YesNo

Is the Secondary Presenter the same person as the Abstract Submitter?*

YesNo

Please provide the following contact information for the secondary presenter below.

First Name*

Last Name*

Credentials

Job Title*

Organization Name*

Mailing Address*

City*

State*

Zip Code*

Phone Number*

Email Address*

Secondary Presenter Bio*

Please note: You are not able to save and continue at a later time. Make sure that you have all of the information you need for your abstract submission saved in another document if you need to exit for any reason.

Please provide the following contact information for the primary presenter below.

Please provide the following contact information for the secondary presenter below.