MPA invites you to submit a proposal to present a pharmacy continuing education program at an upcoming event.

All programs submitted must have a patient-focused care component and be designed for pharmacists in all practice settings, pharmacy technicians and pharmacy students.

Programs should contain a "hands-on" approach, including one or more of the following: question and answer, open forum, illustration and/or physical interaction. We are also emphasizing programs focusing on patient counseling for specific disease states. Programs need to be at least 60 minutes in length.

The proposal will be reviewed, and if your presentation is accepted, we will contact you to finalize arrangements. For more on continuing education programs, contact MPA Director of Continuing Education Mary Farrington.

(form)

Program Title

Program Description (for promotional purposes)

Presenter

Organization

Title

Daytime Phone

E-mail

Address

City

State

Zip Code

Program Learning Objectives (minimum of three required):

1.

2.

3.

4.

5.

Patient-focused Care Component

This program will contain the following components: (checkboxes)

Question & Answer, Open Forum, Physical Interaction (hands-on), Illustrations (slides, patient models, material models, case studies)

Honorarium and Expense Requirements

Please indicate what you will require for reimbursement. (checkboxes)

Honorarium (with space for dollar amount), Roundtrip mileage, Roundtrip coach airfare and airport parking, Meal reimbursement, Hotel overnight

Sponsorship

This program has been sponsored in the past by (list organizations):