APTA Michigan Conference Course Submission Form
Please be aware that course proposals for Fall Conference are due for consideration by June 1st. Please note that speaker honorariums are given for each session, not each speaker. For a detailed list of our speaker policy please email email@example.com
Lead Presenter Name
Lead Presenter Email
Leader Presenter Phone Number
Please enter a valid phone number.
I am traveling from outside of Michigan
Please list all additional presenters below, if applicable (include email). After submission, the speaker line-up should not be increased. If for any reason the original speakers listed can no longer participate, contact APTA Michigan prior to any changes being made:
Fall Conference 2024 (Oct 11-12, The Westin Southfield Detroit)
2025 Dates and Location TBD
Brief Course Description: Please include how/why course content is directly related to physical therapy and how content improves a participant’s knowledge or skills in physical therapy.
Preferred Length of Session
Previous Speaking Experience
Other National Conference
List at least 3 Course/Learning Objectives?
Program or Course bibliography of at least 5 published works, published within the last 7-10 years supporting the content of the course
Conflict of Interest Disclosures
No conflict of interest to declare
List conflict of interest in next box
Conflicts of Interest:
Should be Empty: