47th Annual PSPA Fall CME Conference
Speaker Application Form
Instructions:
  • Complete each field below as directed and submit the electronic form.
    All fields are required.
  • Incomplete submissions will not be considered.
    All fields are required.
  • Applications will be reviewed by the education committee. Applicants will be notified by February 15, 2022 of the status of their speaker application.
Note:
Personal or product promotional presentations are strictly forbidden and will not be considered.
Primary Presenter
If you are currently teaching and are also practicing, please note both titles or positions.
If you are a PA in Pennsylvania, a PSPA Membership is required.
Practice, Facility, Organization
Contact Info
Proposed Presentation
Title is subject to approval and/or change by PSPA.
Provide a brief description of primary issue or research finding, presentation format, and importance of content to medical practice to allow reviewers to judge content (not to exceed 250 words).
Provide three (3) specific and measurable continuing education learning objectives/outcomes for the presentation and for PSPA to use for the CME application to AAPA.
Provide a brief "marketing description" that could be used by PSPA to advertise this presentation to potential attendees.
Speaker Qualifications
List any relevant academic credentials, professional licenses, and/or certifications.
Write a short biographical paragraph for PSPA (not to exceed 150 words).
 
List a maximum of three (3) relevant professional development training or presentations within the last four years:
Provide two (2) presenter reference or links, e.g., Vimeo, YouTube, UStream, Facebook, etc. , in lieu of references.
Speaking in the past in not a requirement for the application.
Miscellaneous
Applications will be kept on file for two (2) years. If you do not want PSPA to keep the application for consideration for the second year, please indicate here.
Secondary Speaker
If you are currently teaching and are also practicing, please note both titles or positions.
If you are a PA in Pennsylvania, a PSPA Membership is required.
Practice, Facility, Organization
Contact Info

Thank you for supporting PSPA.

Acknowledge and Agree

To submit this application you must acknowledge and agree to all of the following:

 

You must be registered for the CME conference to receive CME credit.

 
You are responsible for making your own travel and hotel arrangements.
 
You acknowledge and agree that you may be required to present any session(s) virtually, at the sole discretion of PSPA.
 
You must record and submit a video recording of your presentation(s) prior to the conference.
  Cancel