Speakers

If you would like to submit an abstract to speak at the Midwifery Educators Conference June 16-20, 2010, please fill out the following form. Please carefully read all instructions and provide all necessary information in order to be considered. This information will be used to fill out the CEU application. Fields with an asterisk * are required fields (all fields except cell phone are required) Please submit a separate form for each session Click here to read the full instructions

* Your First Name:	* Your Last Name:
* E-mail address:	* Phone Number:
Cell Phone:
* Mailing Address:	* City:
* State/Province:	* Postal Code:
* Session Title :
* Session Length in minutes (instructions):
* Speaker Name(s) (instructions):
* List Measurable Behavioral Objectives or Learning Outcomes (instructions):
* Describe Session Content (instructions):
* Assessment of Learning Outcomes (instructions): Pre/Post Test Questions Written/Oral Exam Return Demonstration of Skills or Simulations Discussion, Summaries or Case Studies Projects, Plans or Decision Making Exercises Other:
* Has this session been approved for continuing education credits before? (instructions): Yes No If "Yes" when: and where:
*List three (3) Pre and Post session test questions and answers (instructions):
* List the correct number of current references or documentation you have used in preparing this course, PLEASE see instructions for the number of references required for the length of your session (instructions):
* Paste the text of the resume of EACH speaker within this area (instructions):

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