AANEM - Program Proposal Form

Submit Ideas • Program Proposal Form

Annual Meeting Educational Program Proposal Form

NOTE: This form must be filled out completely for your proposal to be considered by the AANEM. Incomplete submissions will be deleted without review. All fields with an" * " are required.



*AANEM Member Name:
*Email:
If you are a member of an AANEM Committee(s), please provide the committee name(s):
If this is a submission by a member of Industry, please provide your company's name:
Proposed *Program Title:
Proposed *Chair/Moderator (Chair/Moderator MUST be members of the AANEM):
Proposed *Faculty (Please limit one per name box):
*Please indicate which type of session you are proposing:	Course - 3.5 hours Experts' Roundtable - 1.25 hours Seminar - 2.25 hours Special Interest Group - 1.75 hours Symposia - 1.75 hours Workshop - 1.75 hours Other
If other, please provide a session type:
and estimated time needed for "other" session type:
*Program Description:
*Objectives:
*Target Audience:
Name:
Address:
City:
State:
Zip Code:
Phone:
Fax:

Submit Ideas

Program Proposal Form