Webinar Submission Form

Presenter Information

Title*

First Name*

Last Name*

Position*

Institution/Company*

Country*

Address*

City*

State/Province*

Postal/Zip Code*

Work Phone( please use dashes)*

Fax (please use dashes)

Email*

Has presenter previously submitted to present, or been chosen to present at ERAPPA?

Co-Presenter Information

Co-Presenter Title

Co-Presenter First Name

Co-Presenter Last Name

Co-Presenter Position

Co-Presenter Institution/Company

Co-Presenter Country

Co-Presenter Address

Co-Presenter City

Co-Presenter State/Province

Co-Presenter Postal/Zip Code

Co-Presenter Work Phone (please use dashes)

Co-Presenter Fax (please use dashes)

Co-PresenterEmail

Webinar Information

Webinar Title (100 character limit)*

Please enter at least four learning objectives (This will be used to obtain approval for AIA LU/PDH credits and is a mandatory requirement) 1500 Character Limit*

Please enter a short abstract (This will be used for advertising the webinar, 200 word limit and is a mandatory requirement)*

Give a brief biography of your qualifications (limit 1000 characters, spaces included and is a mandatory requirement):*