CPDD SYMPOSIUM PROPOSAL by fkm75091

VIEWS: 8 PAGES: 4

									YEAR OF MEETING: _______                            TODAY’S DATE: _______________


                         CPDD SYMPOSIUM PROPOSAL
                           due in CPDD Office by October 15th


This is an application for a ____F ULL SYMPOSIUM    and/or _____   MINI SYMPOSIUM

TITLE:__________________________________________________________________
_________________________________________________________________________


CHAIR: _______________________________              e-mail: _________________________
Address: _______________________________            Phone: _________________________
_______________________________________             Fax:   __________________________
_______________________________________


Co-CHAIR: ___________________________               e-mail: _________________________
Address: _______________________________            Phone: _________________________
_______________________________________             Fax:   __________________________
_______________________________________
SUMMARY (<250 words) to include significance and specific aims of the session. (If accepted,
a modified version, subject to approval by the authors, will be used for publication in the
Program Book. All presenters must issue a Conflict of Interest statement – See guidelines on
CPDD Web site.) Please note that although an individual can be included in multiple
symposium proposals, each person can participate in only one symposium at the
conference. Thus, if multiple symposia are accepted into the program with overlapping
participants, modifications to the participant lists will need to be made. Thus, it is advised
that the Chair inquire as to whether or not speakers are being included in multiple session
proposals.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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                                      Page 1 of 4
CPDD SYMPOSIUM APPLICATION                                    CHAIRS:


______________________________________________________________________________
______________________________________________________________________________

Key Words (5):         _______________                ______________              ____________

                       _______________                _____________


Questions for the Chair (please answer all questions):

1. Have you proposed this same symposium previously to CPDD? Yes /No

If so, list year(s): ___________________________________________________________

2. Have you chaired a symposium or workshop at CPDD in the past 3 years?

If so, list year(s) and title(s): _________________________________________________
_________________________________________________________________________
_________________________________________________________________________

3. Are there any special scheduling issues (e.g., foreign speaker can come to CPDD for
only a limited time)? Yes / No

If yes, briefly state issue(s):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________


4. If you submitted a full symposium, will you accept a Mini-Symposium slot?

____Yes        _____No

Please note that if you check “Yes”, the Program Committee will exercise its judgment in
selecting the three speakers for inclusion in the Mini symposium unless you have identified three
individuals (by asterisk) on the following pages of this application.


5. Would you accept a workshop? (Please see guidelines on workshop application form)
_____Yes      _____No




                                        Page 2 of 4
CPDD SYMPOSIUM APPLICATION                               CHAIRS:


SPEAKERS (confirmed):
Highlight three proposed Mini-Symposium speakers with an asterisk.
Also, clearly indicate who will be the DISCUSSANT.


1. Name:_________________________________________ CPDD Member?        Yes / No
Affiliation:____________________________________________________________________
Complete Address & Zip: ________________________________________________________
_____________________________________________________________________________
Phone & E-mail: _______________________________________________________________
Title of Talk: __________________________________________________________________
______________________________________________________________________________



2. Name:________________________________________ CPDD Member?        Yes / No
Affiliation:____________________________________________________________________
Complete Address & Zip: ________________________________________________________
_____________________________________________________________________________
Phone & E-mail: _______________________________________________________________
Title of Talk: __________________________________________________________________
______________________________________________________________________________



3. Name:_________________________________________ CPDD Member?        Yes / No
Affiliation:____________________________________________________________________
Complete Address & Zip: ________________________________________________________
_____________________________________________________________________________
Phone & E-mail: _______________________________________________________________
Title of Talk: __________________________________________________________________
______________________________________________________________________________




                                     Page 3 of 4
CPDD SYMPOSIUM APPLICATION                                 CHAIRS:


4. Name:_________________________________________ CPDD Member?                   Yes / No
Affiliation:____________________________________________________________________
Complete Address & Zip: ________________________________________________________
_____________________________________________________________________________
Phone & E-mail: _______________________________________________________________
Title of Talk: __________________________________________________________________
______________________________________________________________________________



5. Name:_________________________________________ CPDD Member?                   Yes / No
Affiliation:____________________________________________________________________
Complete Address & Zip: ________________________________________________________
_____________________________________________________________________________
Phone & E-mail: _______________________________________________________________
Title of Talk: __________________________________________________________________
______________________________________________________________________________


PLEASE NOTE: Full symposia are 2 hours in length and may have no more than 5 speakers,
one of whom may be the discussant. This provides approximately 25 minutes for each
presentation (20 minutes for the talk and 5 minutes for questions). The Mini Symposia are 1 hour
and limited to 3 speakers, each with 20 minutes total time. These guidelines are designed to
ensure that speakers have the opportunity to present greater depth and breadth of their topic and
to promote more discussion during the session. Please encourage your discussant to present a
more broad interpretation of the topic rather than focusing just on his/her own work. The
discussant should tie together the prior presentations and encourage discussion from the
audience.

Please note that once the speakers, titles, and the order of their presentation
have been decided (in February), nothing can be changed.
Mail, e-Mail or Fax completed application to Rochelle R. Davis, CPDD, Center for Substance
Abuse Research, Temple University School of Medicine, 3400 N. Broad Street, Philadelphia, PA
19140. Fax (215) 707-1904; e-mail: rdavis04@temple.edu

A confirmation that our office has received your symposium will be faxed to the CHAIR of the
Symposium. If you do not receive a confirmation, please contact our office immediately at
215-707-3242.

Fax number to receive confirmation ________________________




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