Educational activity information
* required information
Educational activity marketing summary 
Contact Information
Please complete this form to assist us in marketing and promoting your educational activity.
Title:
First Name:*
Middle Initial:
Last Name:*
Email:*
ZIP/Postal Code:*
Phone:*
Fax:
Cell Phone:
Title of activity:*
Activity start date:*(mm/dd/yyyy)
Activity end date:*(mm/dd/yyyy)
Faculty listing (you can update this at any time by returning to the form):*
Description of the activity (for marketing):*
Learning Objectives (3):
Topics covered (please list at least 5):*
Activity type::* General session
Preconference workshop
Sunset session
Other activity
Why should attendees attend this workshop?:*
Attach any relevant documents here (outlines, schedules, etc): Click here to attach file