Session Proposal 2020

Thank you for your interest in presenting at our upcoming Annual Meeting in May. Please complete the following form and provide information about the session you wish to present so that we may consider request. The Maine ACS Program Committee will decide whether this meets with the content goals and theme of the conference and get back to you with feedback and a decision.

Your Contact Information

First Name Last Name
Daytime Phone
Email

Primary Presenter Information

Presenters First Name Presenters Last Name
Credentials
Title
Company
Daytime Phone
Email

Other Presenters Information

Presenters First Name Presenters Last Name
Credentials
Title
Company
Daytime Phone
Email
Please list additional presenters here: (First Name, Last Name, Credentials)
 

Session Description

Session Title
Description of proposed session (200 Words Max)
 
List any special equipment required for this session. (We provide computer, projector, pointer, microphone, podium, etc.)
 

Agreement

The Maine Chapter, American College of Surgeons, hereinafter referred to as Maine Chapter, appreciates your submission and will consider this at one of their upcoming program committee meetings. Someone from the committee will be in touch to discuss this proposal. If your proposal is accepted, the Maine Chapter will confirm availability with the primary speaker and reserve a spot on the agenda for this session. The Maine Chapter reserves the right to decline any proposal that is not in keeping with the theme or character of the meeting.
I have read and agree to the terms and conditions of this form and the Exhibitor Agreement
(please initial)

Tax ID # 20-4019098
(The MEACS W-9 Form can be requested by emailing maine@mainefacs.org)
   - denotes required fields