CALL FOR PRESENTATIONS SUBMISSION FORM

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					                    EDUCATION PRESENTATION
                       SUBMISSION FORM
                          CLSA Annual Education Meeting
                         0B




                                April 25-28, 2012
                              Newport Beach, California

              APPLICATION DEADLINE: August 15, 2011
             1B




The Contact Lens Society of America is pleased to invite your submission of contact
lens related courses at the 2011 Annual Education Meeting. Courses will be held
from Wednesday, April 25 through Saturday, April 28, 2012 at the Newport Beach
Marriott Hotel & Spa. Courses submitted cover a wide variety of contact lens related
topics. All abstracts must be submitted electronically via email to clsa@clsa.info by
        U                                                             U




the submission deadline of August 15, 2011.

            PLEASE SUBMIT BY ELECTRONIC MAIL TO: clsa@clsa.info

1. Category of Presentation:
     10 Minute General Session Talk              One-Hour Course
     Other

2. Title of Presentation:

3. Instructor(s):

4. Current Curriculum Vitae. Include one for each instructor listed. Please insert
   here by cutting and pasting with your word processor.


5. Biographical Sketch. 100 words or less, include one for each instructor listed.
   Please insert here by cutting and pasting with your word processor.


6. Level of Presentation: (Check one only)                  Level 1       Level 2   Level 3

7. Prerequisites: (if any, required for Level 3 Courses)

8. Instructional Objectives. Provide at least 1 objective, e.g., “At the conclusion of
   this presentation the participant will have learned…,” for a 10 minute presentation
   and 3 for each hour. Please insert objectives here by typing or by cutting and
   pasting with your word processor.


9. Topic Outline. A detailed outline is required for all presentations. Each specific skill
   should be listed as a main topic, and there should be not less than three main topics per
   credit hour. Outline must be timed. Please insert outline here by cutting and pasting
   with your word processor.



                                 (Continued on Next Page)
10. Course Description. 100 words or less describing the presentation, to be
    published in the preliminary program. Please insert course description here by
    typing or by cutting and pasting with your word processor.



NOTE: Course content Umust be generic in nature and presented in an objective
manner. By submitting this submission form for the CLSA Annual Education
Meeting, you pledge that course content will be presented in a generic and objective
manner.




      Submit completed form to:      Carri Ferguson, FCLSA, Education Committee
                                     Contact Lens Society of America
                                     441 Carlisle Drive, First Floor
                                     Herndon, VA 20170
                                     (703) 437-5100  FAX (703) 437-0727
                                     e-mail: clsa@clsa.info

                Note: Incomplete applications will not be considered.

Please be sure you complete each section and attach required additional information.

				
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