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MAPA 2020 Spring CME
March 21, 2020 Spring CME Conference Request for Speakers
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* Indicates required question
Michigan Academy of Physician Assistants
First Name
*
Your answer
Last Name
*
Your answer
Credentials
*
Your answer
email address
*
Your answer
Speaker Title
*
Your answer
mobile phone
*
Your answer
Speaker Company/Organization
*
Your answer
Speaker Bio
*
Your answer
Honorarium - per session
*
Yes - (W-9 is required - see below)
No thank you - I would like to donate back to MAPA
Honorarium
(W-9 is required -
https://www.michiganpa.org/page/2020SpringCME
)
Session Title
*
Your answer
Session Title
CME Disclosure form is required -
https://www.michiganpa.org/page/2020SpringCME
)
Session Description
*
Your answer
Learning Objective #1
*
Your answer
Learning Objective #2
*
Your answer
Learning Objective #3
*
Your answer
Intended Audience
*
Fellow PA
PA Student
Will your session have additional speakers
Yes
No
Clear selection
(If Yes) Additional Speaker First Name
Your answer
(If Yes) Additional Speaker Last Name
Your answer
(If Yes) Additional Speaker Credentials
Your answer
(If Yes) Additional Speaker email
Your answer
(If Yes) Additional Speaker - mobile phone
Your answer
Submit
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