Toronto PMRC Speaker Information Form Question Title * 1. Session Title Question Title * 2. Speaker (enter position and organization as you would like them listed in the program) Name Position Organization Email Phone Question Title * 3. Audio-Visual Equipment A computer and data projector will be provided. Please specify any additional equipment required: Question Title * 4. Educational Objectives: Please list 3 or more. The objectives should be written from the perspective of the learner, descriptive of what the learner will gain in knowledge, skills and attitudes as a result of participating in the event; and written to enable evaluation of achievement by the planners and participants. Please use verbs that denote an observable action, such as “list, explain, summarize, discuss, compare, etc.” NOTE: It is no longer permitted to use words that indicate emotions or feelings such as “know, learn, appreciate, understand, recognize, etc.” For a list of actionable words, please reference the "Speaker Information" page on the conference website. At the end of the session, the participants will be able to: 1 2 3 4 5 6 Question Title * 5. Description: Please provide a summary of your presentation. At the end of your summary please indicate your target audience, for example, “The session will be of value to: Physiatrists, Medical Students, Residents.” Question Title * 6. Biography: Please provide a short bio (1-2 paragraphs) Question Title * 7. The Toronto Physical Medicine & Rehabilitation Conference can make my presentation available to individuals who may be interested in accessing it by posting it on their national association website. Yes No Comment: Question Title * 8. Speaker Signature and Date: I, the undersigned, the author of this presentation, certify that I have obtained all customary and necessary permission to use and print any copyright material that appears in my presentation. Speaker Name Date Done