Full Name

Company

Title

Address Line 1

Address Line 2

City

State

Zip

Email Address

Phone Number

Cell Phone

Are you a PBMI Corporate Member?

YesNo

Title of Presentation

Speaker/Presenter Information

Presentation Description

Please provide an overview of your presentation (max. 500 words)

Have you presented this topic at another conference?

YesNo

Which conference?

Suggested Panelists/Co-Presenters (3-4 Individuals)

Learning Objective #1

Learning Objective #2

Learning Objective #3

Learning Objective #4

Which education track best fits your presentation?

Submitted by:

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Speaker Biography

Please provide a biography as it would appear in print. (max. 150 words)

Speaker Availability (Check all that apply)

Wednesday - September 6, 2023Thursday - September 7, 2023Friday - September 8, 2023

If requested, I can present this session more than once during the conference.