Abstract Submission Form

Thank you for your interest in presenting a workshop at ACU's Annual Conference & Workforce Forum: "Empowering Clinicians and Communitiesat the Westin Alexandria in Alexandria, VA, June 1-3, 2015. Please provide the information requested below.  (Accepted presenter(s) will be responsible for all travel costs and conference registration fees.)

 
1.

Please select the best category that your topic aligns with:

Clinical Quality & PCMH
Workforce Recruitment & Retention
Health Information Technology & Meaningful Use
Patient and Community Engagement
Special program for a unique population (e.g. migrant, homeless, public housing)
Other  
2.
Workshop Title:
 

350 characters left.
3.

Description (Maximum of 200 words):

 

1000 characters left.
4.

Learning Objective #1: 

 

350 characters left.
5.

Learning Objective #2:

 

350 characters left.
6.

Learning Objective #3:

 

350 characters left.
7.

Contact Information for the Moderator:


By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
City:
State/Province
(US/Canada):

8.

Name, title and contact information for any additional speakers/presenters:

 

1000 characters left.