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2025 IACFS/ME Conference Workshop
Submission Form:
Due May 5, 2025 at 5 PM
(New York City, USA time)
Please complete the form below in order for your work to be considered for the 2025 IACFS/ME Conference.
To convert the date/ time for the deadline to your geographic area, check
https://www.timeanddate.com/worldclock/converter.html
.
After you submit this form, you will receive a copy of your submission at the e-mail address you enter directly below. If you do not see it, search for "Google Forms" within your e-mail. Please keep this copy for your records.
If you have any questions, please complete our Contact Us form:
https://members.iacfsme.org/contact
Choose "Conferences" as the "Nature of Inquiry."
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Email
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Your email
Presentation Title
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Presenter Name (e.g. Jane Smith)
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Your answer
Presenter Academic Degree(s) (MD, PhD, MBBS, DSc, etc.)
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Your answer
Presenter Academic/Hospital/Organization Affiliations (If none, please enter "None".)
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Presenter's Email Address
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Presenter's Telephone Number (Please be sure to include your country code and do not include dashes. For example, "+14253489087")
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Presenter's Mailing Address Line 1
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Presenter's Mailing Address Line 2 (optional)
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City
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State/ Province (Write "Not Applicable" if this does not apply.)
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Zip/ Postal Code (Write "Not Applicable" if this does not apply.)
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Country
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United States
Canada
England
Australia
Japan
Other:
Co-Presenter 1 (You may choose to have up to 2 co-presenters. Please enter their name. For example, "Maria Vargas." If none, please enter "None". )
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Co-Presenter 1 Academic Degree(s) (MD, PhD, MBBS, DSc, etc.)
Your answer
Co-Presenter 1 Academic/Hospital/Organization Affiliations (If none, please enter "None".)
Your answer
Co-Presenter 1 Email Address
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Co-Presenter 1 Telephone Number (Please be sure to include your country code and do not include dashes. For example, "+14253489087")
Your answer
Co-Presenter 1 Mailing Address Line 1
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Co-Presenter 1 Mailing Address Line 2 (Optional)
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Co-Presenter 1 City
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Co-Presenter 1 State/ Province (Write "Not Applicable" if this does not apply.)
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Co-Presenter 1 Zip/ Postal Code (Write "Not Applicable" if this does not apply.)
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Co-Presenter 1 Country
United States
Canada
England
Australia
Japan
Other:
Clear selection
Co-Presenter 2 (You may choose to have up to 2 co-presenters. Please enter their name. For example, "David Lee." If none, please enter "None". )
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Co-Presenter 2 Academic Degree(s) (MD, PhD, MBBS, DSc, etc.)
Your answer
Co-Presenter 2 Academic/Hospital/Organization Affiliations (If none, please enter "None".)
Your answer
Co-Presenter 2 Email Address
Your answer
Co-Presenter 2 Telephone Number (Please be sure to include your country code and do not include dashes. For example, "+14253489087")
Your answer
Co-Presenter 2 Mailing Address Line 1
Your answer
Co-Presenter 2 Mailing Address Line 2 (Optional)
Your answer
Co-Presenter 2 City
Your answer
Co-Presenter 2 State/ Province (Write "Not Applicable" if this does not apply.)
Your answer
Co-Presenter 2 Zip/ Postal Code (Write "Not Applicable" if this does not apply.)
Your answer
Co-Presenter 2 Country
United States
Canada
England
Australia
Japan
Other:
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Please tell us about your workshop proposal. Which audience is this workshop primarily intended for? Please choose one.
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Clinicians (doctors, nurses, pharmacists, psychologists, etc.)
Scientists and researchers
Patients, caregivers, lay public
What level of knowledge should the audience possess beforehand for the topic of your workshop? For example, if the audience should already be somewhat familiar with your topic, then the workshop should be rated "Intermediate." Please choose one.
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Introductory
Intermediate
Advanced
Please describe the CONTENT of your workshop. What information will be shared or discussed with attendees? Your description will be shared with attendees. (125 words maximum)
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Your answer
Please describe the FORMAT of your workshop. For example, small group discussion, lecture, demonstration, role play, etc. Your description will be shared with attendees (125 words maximum)
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Your answer
What will attendees learn from your workshop? List 3 learning objective by completing this sentence: "By the end of this workshop, participants will be able to......." Use action verbs that are potentially measurable: e.g., Describe, Perform, Formulate, Critically appraise, Compare, Summarize. Avoid these less precise verbs: Understand, Be aware, Discuss, Appreciate. For example, "1. Compare treatment x to treatment y; 2. Describe how metabolic dysfunction contributes to fatigue; 3. Formulate an approach to diagnosing metabolic issues." (75 words maximum) For more guidance, see this website:
http://jeffline.jefferson.edu/jeffcme/application/intake/files/guidelines_learning_objectives.pdf
.
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Your answer
List 3 resources (e.g. articles, websites, videos, etc.) attendees can use to learn more about your topic. Please cite resources using AMA format. See:
https://guides.med.ucf.edu/ld.php?content_id=58246564
.
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Your answer
Please describe how you (and your co-presenter(s)) are qualified to present on his subject (e.g. educational background, professional experiences, etc.). (200 words maximum)
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Your answer
Off-Label Use
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This presentation DOES include information about off-label or investigational use of product(s)/ procedure(s). (Please specify in next item). I understand that I must disclose this information to the audience prior to the presentation.
This presentation DOES NOT include information about off-label or investigational use of product(s)/ procedures. .
Off-Label or Investigational use of Procedure(s)/Product(s): Please be specific. If there are none, write "None."
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Your answer
Who provided support/funding for this workshop? Include the grant identification number if available. Please enter "None" if not applicable.
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Your answer
Financial Conflict of Interest
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I (We) DO NOT have a Financial Conflict of Interest
A Financial Conflict of Interest DOES EXIST. I (We) understand that it is necessary that the conflict of interest be identified openly at the beginning of my presentation so that the audience may form their own judgements. (Please also specify the conflict in the next item and how you are conflicted.)
Nature of Financial Conflict: Be specific. If more than one person is presenting, list presenter name and their associated conflict(s). If "none" please enter "None".
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Your answer
Other Commercial Affiliations - If you (and/or your co-presenters) are employed by or associated with any commercial/ for-profit entities (whether they have to do with your presentation or not), please disclose that here.
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I (We) AM (are) NOT AFFILIATED with ANY commercial entities.
I AM (We are) AFFILIATED with a commercial entity. (Please complete next section.)
Nature of Commercial Affiliation: Be specific: list your/ presenter name (if more than one presenter), company name, and your/ their position (e.g. employee, speaker, consultant, advisor, etc.). If presenters are not affiliated with any company, please enter "None".
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