Presenter Information
 
First Name*
 
 
Last Name*
 
 
 
Credentials
 
 
 
Email*
 
 
 
Phone Number*
 
 
 
Job Title*
 
 
 
Company Name*
 
 
 
Address 2: Street 1
 
 
 
Address 2: City
 
 
Address 2: State
 
 
 
Address 2: Zip/Postal Code
 
 
Address Type
 
 
 
 
 
 
Professional Experience*
 
 
 
 
 
Daily Job Duties
 
 
 
 
 
Presenter's Short Bio-Sketch (Limit to 175 words)*
 
 
 
 
 
Presenter's Previous Speaking Experience (Include in-services, state, or national conferences, etc.)*
 
 
 
 
 
Reference (If you are a first-time AAPACN presenter, please provide at least one reference who can attest to your experience as a presenter. List the name, email, phone number, and relationship to you.)
 
 
 
 
 
Presenter Photo (Please upload a professional photo that may be used in conference promotional materials.)
 
 
 
 
 
Co-presenter Information (Only for Sessions with Co-presenter)
 
Co-presenter Name
 
 
 
Co-presenter Credentials
 
 
 
Co-presenter Job Title
 
 
 
Co-presenter Company Name
 
 
 
Co-presenter Email
 
 
 
Co-presenter Phone
 
 
 
Co-presenter Street Address
 
 
 
Co-presenter City/State
 
 
Co-presenter Zip Code
 
 
 
 
 
 
Co-presenter Professional Experience
 
 
 
 
 
Co-presenter Short Bio-Sketch (Limit to 175 words)
 
 
 
 
 
Co-presenter's Previous Speaking Experience (Include in-services, state, or national conferences, etc.)
 
 
 
 
 
Co-presenter Reference (If you are a first-time AAPACN presenter, please provide at least one reference who can attest to your experience as a presenter. List the name, email, phone number, and relationship to you.)
 
 
 
 
Session Information
 
Suggested Session Title (Limit to 10 words, be clear and concise)*
 
 
 
 
 
Suggested Session Description (Begin with a one-sentence explanation as to why this topic is important and timely, followed by why it is relevant to the AAPACN audience. Limit to 80 words.)*
 
 
 
 
 
Session Complexity*
 
 
 
 
 
Session Format and Teaching Engagement Strategies (Check all that apply). 
Lecture
 
 
 
 
Case Study
 
 
 
 
Small Group Discussions
 
 
 
 
Panel
 
 
 
 
Q&A
 
 
 
 
Video
 
 
 
 
Demonstration
 
 
 
 
Role Play
 
 
 
 
Other
 
 
 
 
 
 
 
Suggested Target Audience (Job titles and role in facility)*
 
 
 
 
 
Learning Objective #1 (Limit to 20 words)*
 
 
Learning Objective #2 (Limit to 20 words)*
 
 
Learning Objective #3 (Limit to 20 words)
 
 
Learning Objective #4 (Limit to 20 words)
 
 
 
 
Nursing CEs
 
Cite a Source (article, press release, piece of legislation, etc.) that demonstrates that this is a topic about which nurses need education.
 
 
 
 
 
Define the gap in knowledge, skills, or practice for the learner that your education session is designed to improve.
 
 
 
 
Wrap-up
 
Thank you for your submission! Please use this section to share with the content committee any additional information that would help them make their decision.