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  • Protecting Public Health and the Environment

Your Name

Abstract Title

Application Submittal Date


Title of Program

Sponsoring Chapter or Committee

Number of Contact Hours Proposed

Titles of Presentations to be Reviewed for PDHs

Submitter Email

Submission Password

Primary Topic

Secondary Topic

Speaker Name Title

Speaker First Name

Speaker Last Name

Speaker Employer

Speaker Email

Speaker Phone

Speaker Cell

Speaker Address

Speaker City

Speaker State

Speaker Zip

Speaker Job Title

Speaker Job Description

Speaker Major Projects

Speaker Related Experience to Presentation

Speaker Previous Employment

Speaker Education

Speaker Licenses

Co-Author 1 Name

Co-Author 1 Employer

Co-Author 2 Name

Co-Author 2 Employer

Co-Author 3 Name

Co-Author 3 Employer

Mini-Abstract Description

Abstract Description

Presentation Learning Objective

Continuing Education Elements

Will there be a Co-Presenter?

Name of Co-Presenter

Co-Presenter's Email

Are You a Student?

Check if you are an invited speaker for a particular session?

Enter session name (if invited speaker)


Content Type: Item
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