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* 1. First Name, Last Name, Credentials

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* 2. Are you a PAFP member?

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* 3. Preferred Phone Number and Email

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* 4. Have you spoken at a previous PAFP CME Conference?

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* 5. I am applying for the following conferences/events (please check all that apply)

TOPICS

Below are the suggested areas of focus most requested by our members. Speakers are encouraged to develop a presentation focusing on one of the below, although topics outside of these suggestions will certainly be considered provided they are germane to primary care. You will be asked for a session title and learner objectives within this application.

  • Behavioral/Mental Health
  • Cardiology
  • Child Protection (Act 31)
  • Dermatology
  • Endocrinology
  • Gastroenterology
  • Geriatrics
  • Hospice/End of Life Care
  • Hospital Medicine
  • Infectious Disease
  • Leadership/Career Advancement
  • Lifestyle Medicine
  • Men's Health
  • Neurology
  • Oncology
  • Opioids/MOUD
  • Orthopedics/Procedures
  • Pain Management
  • Pediatrics
  • Physician Wellness/Wellbeing
  • Practice Management, i.e. Billing, Coding, Staffing, Practice Efficiency, Administrative Burden, etc.
  • Procedures: splinting, casting, MSK
  • Sleep Medicine
  • Sports Medicine/Musculoskeletal
  • Technology
  • Wellness/Wellbeing
  • Women’s Health
  • Other
PRESENTATION TYPES
  • Didactic Presentation with one presenter – time needed including Q & A: 30 mins - 60 mins
  • Didactic Presentation with a co-presenter – time needed including Q & A: 30 mins - 60 mins
  • Procedures Workshop with one presenter - Up to 2 hours maximum of hands-on procedures
  • Procedures Workshop with a co-presenter - Up to 2 hours maximum of hands-on procedures
  • Panel Discussion
  • Round Table Case Studies
  • Interactive Lecture
YOUR SPECIFIC SESSION (S)

Please use the space below to enter the information about the specific session(s) you would like to present at a PAFP CME Conference.

Include:
  • The topic, be as specific as possible - see above
  • Practice Gaps - What is the practice-based problem you are addressing?
  • Learner Objectives
  • Presentation type - see above
  • Complexity level
    Beginner is learning the fundamentals with some familiarity.
    Intermediate is applying new knowledge to build foundation of experience.
    Advanced is extensive competency of complex concepts.

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* 6. Will you have a co-presenter?

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* 7. If yes, please include their name and credentials here and attach their bio as you will at the end of this form.

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* 8. Session #1

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* 9. Session #2 (if applicable)

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* 10. Session #3 (if applicable)

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* 11. Past Experience
Please upload a brief bio including previous speaking experience, topics, audience and evaluation summaries if available.

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APPLICATION REVIEW PROCESS
Applications are reviewed as they are received from PAFP and can be submitted any time before the deadline. Applications submitted after the deadline may be accepted if there is an opening on the event agenda. Upon approval of your application, you will be notified confirming your participation and specifics.

Thank you for applying to present at a PAFP CME Conference.

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