Speaker Application

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.

Speaker Application
Program Title:
Program Description (for promotional purposes):
Presenter:
Organization:
Title:
Daytime Phone:
E-mail:
Address:
City:
State:
Zip Code:
Program Leaning Objectives (minimum of three required):
1.
2.
3.
4.
5.
Patient-focused Care Component
This program will contain the following components:
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:
Honorarium $
Roundtrip mileage
Roundtrip coach airfare and airport parking
Hotel overnight
Sponsorship
This program has been sponsored in the past by (list organizations):

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