NYACP Call For Speakers Form

The NY Chapter ACP invites physicians who are exceptional speakers and experts in their fields to speak at the Chapter's Scientific Meeting, District Meetings, and other Chapter sponsored educational activities. If you have a topic you would like to present, please complete the form below.

Introduction

ACP Membership Number
First Name *
Last Name *
Credentials
Institution/Practice *
Title *
Speaker Bio (2,000 Character Limit): *
(Maximum characters: 2000)
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Contact Information

Phone:
Email Address *
Address
City
State
Zip

Proposed Session

Please list the topics you would like to present at a Chapter Event:
Session Abstract/Description: *
(Maximum characters: 2000)
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Why is this topic important to the audience? *
(Maximum characters: 500)
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How long is your presentation? *
Who are the intended participants?
At the conclusion of the activity, the participant will be able to:
Upload a presentation example:
Link to a video sample (if available)

Additional Topics

The Chapter staff, leaders and committees are always interested in hearing ideas for educational topics.  If there are topics you would like to see at an event, please share them below.

Which of the following topics are you most interested to learn more about?
None of the above? Share your ideas for additional topics that would inspire you and others to attend an NYACP event!
(Maximum characters: 500)
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