2010 Workshop Submission Form

December 2-5, 2010

Boca Raton Resort & Club, Boca Raton, FL, USA

Invited speakers MUST submit slides for inclusion in participant materials. Principal authors will be notified of review decisions by August 1st, 2010.

Principal Author & Degree (Example: John Doe, MD): *

Institutional Affiliation: *

Address Line 1: *

Address Line 2:

City: *

State: *

Zip/Postal Code: *

Telephone: *

Fax:

Email: *

Additional Presenters::

(Type in author name, degree and institutional affiliation in upper and lower case letters.) Example: John Doe, MD, University of Michigan; Jane Smith, MD, University of Miami; and Pat Johnson, PhD, Harvard University.

AV Request: *

Due to budget restraints, AAAP is NOT able to supply laptops to presenters. If you are planning to use an LCD projector, please make arrangements to supply your own laptop.

Workshop Title (NOT to exceed 15 words): *

Learning Objectives (State the objective of the workshop. A learning objective clearly states what someone will learn as a result of the presentation.): *

Workshop Summary (Describe the workshop in 250 words or less): *

Contents and Methods (Describe the identified objectives to be accomplished.): *

Source of Funding (Indicate source of funding, i.e., NIH Institute, Foundation, Health Care Company, Pharmaceutical, etc): *