ASATT – Call for Proposals 2017Page 1

Speaker Proposal Form

Please complete this form, then email or fax the proposal in MS Word or PDF format. Send the email attachment to include in the subject line Call for Proposal. If you choose to fax your proposal, please fax to the attention of Alex Llanas @ 414-768-8001.

  1. Presenter(s):

Names:

  1. Presentation Format: (Place X in space provided.)

50-60 minute session OR multiple 50-60 minute sessions

III. Details of Presentation

  1. Title of Presentation:Maximum 20 words
  1. Presentation Description
  • Include summary of main points, information and/or techniques to be presented.
  • Description should be 500 words or less using double-spaced, 12-point font.
  1. Learner Outcomes
  2. Outcomes should explicitly state what you expect the participants to learn or be able to do by the end of your presentation.
  3. Outcomes should be stated in a maximum of 20 words per outcome

Participants will be able to:

D. Topic Category: (Select one category and one topic indicate with a X )

Category I Category II

Operating Room tasks Stress Management

Infection Control Techniques Interpersonal Disciplines

Anatomy and Physiology Computer Programs

Types of Anesthesia Data Record Keeping

Intravenous Therapy Materials Management

Monitors and Ancillary Devices Marketing

Pharmacy Quality Assurance Training

Airway Equipment

Anesthesia Gas Machine and

Gas Delivery

E. Target Audience:

The presentation is best suited forallied health professionals serving the following populations (check all that apply):

NeonateObstetric

Pediatric Adults

Teen Geriatric

F.Level of Expertise

NOTE: Most attendees and allied health professionals have at least anAssociate degree or equivalent experience and expect high-level, fast paced presentations.

Beginner: students and professionals new to the field of anesthesia.

Intermediate: professionals working in the field as Certified Technician or Technologist, CRNA, MD or other related health care professional for at least 5 years

Advanced: seasoned professionals who have considerable knowledge and

experience or as an educator in the field

VI.Biographical Statement, Curriculum Vita, or Resume (insert or attach)

VII. Presenter Information

H.Contact Information

Primary Presenter:

Name: / Credentials:
Address:
Address:
City: / State: / Zip Code:
Day Phone: / Home Phone:
Email:

Proposal for Presentation

  1. Each proposal must be submitted with:
  2. Speaker Proposal Form
  3. Description of Presentation
  4. Resume or CV
  5. There is no compensation for Presentation Speakers. Speakers must pay for their own travel and hotel arrangements.
  6. All technician/technologist speakers must register for the conference. Presenters willreceive a Complementary conference registration rate.* Presenters can earn 1 CE for presenting, and 2 for preparing the presentation.
  7. The official language of the conference is English. All informational material, proceedings, and presentations will be in English.
  8. Deadline for proposal submission is Friday, April30, 2018
  9. Notification of acceptance will be no later than Friday, May15, 2018

*Must meet continuing education guidelines. Contact ASATT HQ for details

All presenters must sign this agreement. (If there is more than one presenter, please sign below.)

Signed:

Print name:

Date:

Signed:

Print name:

Date:

Signed:

Print name:

Date:

The entire Speaker Proposal Form must be completed and to ASATT prior to the submission deadline.