CPDD 2019 Full Symposium Application

It is recommended that you compile all information necessary for completing this form in a word document (or other similar document) prior to completing this application. You will not be able to save your work on this form and return later to finalize and submit it.

PLEASE NOTE: Full symposia are 2 hours in length and may have no more than 5 speakers, one of whom must be the discussant. This provides approximately 25 minutes each for four presentations (20 minutes for the talk and 5 minutes for questions), and 20 minutes for the discussant. These guidelines are designed to ensure that speakers have the opportunity to present greater depth and breadth of their topic and to promote more discussion during the session. Please encourage your discussant to present a more broad interpretation of the topic rather than focusing just on his/her own work. The discussant should tie together the prior presentations and encourage discussion from the audience

Due to the limited number of slots for speakers, the Program Committee will select a speaker for only one symposium or workshop.

Once the speakers, titles, and the order of their presentation have been decided (in February), nothing can be changed.

When you are notified that your proposal has been accepted for inclusion in the program, you must relay the information to the co-chair and speakers, reconfirm their participation, their member status (member/non-member), and transmit this information in a timely fashion to our office. Fifty percent of the early bird rate registration fees will be waived for up to 5 speakers in a full symposium. Please list the names and member status of every person who is to be waived. We need the information prior to the individual’s attempting to register. You should remind all participants that they must register online for the meeting, using the appropriate code provided by the chair, and reserve rooms in the hotel. It is expected that all speakers will attend at least a few days of the meeting and not limit their participation to the one session in which they are presenting.

*The Program Committee will exercise its judgment in deciding whether full symposia should be altered due to programmatic needs. In the event that a full symposium is altered, the Program Chair will contact the Symposium Chair to discuss what changes are requested.

Title of Symposium*

Chair*

First NameLast Name

Chair's E-mail*

Chair's E-mail 2nd entry*

E-mails do not match.

Chair's Phone

Area CodePhone Number

Chair's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Co-Chair's Name*

First NameLast Name

Co-Chair's E-mail*

Co-Chair's E-mail 2nd entry*

E-mails do not match.

Co-Chair's Phone

Area CodePhone Number

Co-Chair's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Summary (No more than 250 words; do not duplicate speaker information or talk titles here) to include significance and specific aims of the session. (If accepted, a modified version, subject to approval by the authors, will be used for publication in the Program Book. All presenters must issue a Conflict of Interest statement – See guidelines on CPDD Web site.)*

0/250

Key Words (Up to 5)*

0/5

Speaker 1*

First NameLast Name

Is Speaker 1 a CPDD Member?*

Speaker 1's Affiliation*

Speaker 1's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Speaker 1's E-mail*

Speaker 1's E-mail 2nd entry*

E-mails do not match.

Speaker 1's Phone*

Area CodePhone Number

Title of Speaker 1's Talk*

Speaker 2*

First NameLast Name

Is Speaker 2 a CPDD Member?*

Speaker 2's Affiliation*

Speaker 2's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Speaker 2's E-mail*

Speaker 2's E-mail 2nd entry*

E-mails do not match.

Speaker 2's Phone*

Area CodePhone Number

Title of Speaker 2's Talk*

Speaker 3*

First NameLast Name

Is Speaker 3 a CPDD Member?*

Speaker 3's Affiliation*

Speaker 3's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Speaker 3's E-mail*

Speaker 3's E-mail 2nd entry*

E-mails do not match.

Speaker 3's Phone*

Area CodePhone Number

Title of Speaker 3's Talk*

Speaker 4*

First NameLast Name

Is Speaker 4 a CPDD Member?*

Speaker 4's Affiliation*

Speaker 4's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Speaker 4's E-mail*

Speaker 4's E-mail 2nd entry*

E-mails do not match.

Speaker 4's Phone*

Area CodePhone Number

Title of Speaker 4's Talk*

Discussant's Name*

First NameLast Name

Is Discussant a CPDD Member*

Discussant's Affilation*

Discussant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Discussant's E-mail*

Discussant's E-mail 2nd entry*

E-mails do not match.

Discussant's Phone*

Area CodePhone Number

Title of Discussant's Talk*

Are all speakers confirmed?*

YesNo

Speakers with Registration Fees to be Waived (Select up to 5, including Discussant) *

Have you proposed this same symposium to CPDD before?*

YesNo

Years proposed

Have you chaired a workshop or symposium at CPDD in the past 3 years?*

YesNo

Years and Titles of Past Workshops and/or Symposia

Describe any special scheduling issues (e.g., foreign speaker can come to CPDD for only a limited time)?

Do you require AV equipment?*

YesNo

Describe AV needs

Would you accept a workshop? (Please see guidelines on workshop application form)*

YesNo

A Thank You page will be displayed when you have successfully submitted this form. A confirmation that we have received your symposium and a PDF of your submission will be emailed to the address you provide below. If you do not receive a confirmation within 24 hours of submission, please contact the program chair, William Stoops, at william.stoops@uky.edu, or the director of the Executive Office, Ellen Geller at gellerellen@gmail.com.

E-mail address to send confirmation*

E-mail address to send confirmation 2nd entry*

E-mails do not match.

Enter the message as it's shown*

CPDD 2019 Full Symposium Application

Form must be submitted by 11:59 PM Eastern Time on October 15