Submit a Roundtable or Workshop Proposal

SACRPH 2022 ROUNDTABLE and WORKSHOP SUBMISSION FORM

DIRECTIONS

Please use this form to submit a roundtable or workshop proposal to the SACRPH 2022 Program Committee. At the bottom of the form, please upload a SINGLE PDF or Word file with the following: 1) Cover page with roundtable/workshop title and list of participants; 2) Overview of the session’s themes, significance, and format, in 100 words or less; 3) Discussion of potential contributions of participants (if not in Overview); 4) One-page CV for each participant. For the filename, please use this nomenclature: “Format, Short Title”.

Roundtable or Workshop Session Title *

Please propose a succinct title for your program.

Is this roundtable or workshop available virtually October 20 or in-person on October 22, or EITHER? *

ONLY virtually, Thursday, October 20
ONLY in-person, Saturday, October 22
EITHER virtually (October 20) OR in-person (October 22)

Keywords for Roundtable or Workshop *

Please provide four keywords identifying the thematic emphases of the topic.

How many people will participate in this roundtable or workshop, NOT including the Chair? *

CHAIR and LEAD CONTACT

Roundtable or Workshop Chair and Lead Contact: Name *

First

Middle

Last

Chair and Lead Contact: Institution or Professional Organization *

Chair and Lead Contact: Email *

Chair and Lead Contact: Time Zone for Virtual Presentation *

In what time zone would this person potentially be presenting from?

Mobile Phone Number *

PARTICIPANT 1

Participant 1: Name *

First

Middle

Last

Participant 1: Institution or Professional Organization *

Participant 1: Email *

Participant 1: Time Zone for Virtual Presentation *

In what time zone would this person potentially be presenting from?

PARTICIPANT 2

Participant 2: Name *

First

Middle

Last

Participant 2: Institution or Professional Organization *

Participant 2: Email *

Participant 2: Time Zone for Virtual Presentation *

In what time zone would this person potentially be presenting from?

PARTICIPANT 3

Participant 3: Name *

First

Middle

Last

Participant 3: Institution or Professional Organization *

Participant 3: Email *

Participant 3: Time Zone for Virtual Presentation *

In what time zone would this person potentially be presenting from?

PARTICIPANT 4

Participant 4: Name *

First

Middle

Last

Participant 4: Institution or Professional Organization *

Participant 4: Email *

Participant 4: Time Zone for Virtual Presentation *

In what time zone would this person potentially be presenting from?

PARTICIPANT 5

Participant 5: Name *

First

Middle

Last

Participant 5: Institution or Professional Organization *

Participant 5: Email *

Participant 5: Time Zone for Virtual Presentation *

In what time zone would this person potentially be presenting from?

FINAL NOTES AND UPLOAD

Additional Notes for SACRPH 2022 Program Committee (Optional)

Upload a SINGLE PDF or Word file, per directions below. *

Click or drag a file to this area to upload.

Please upload a SINGLE PDF or Word file with the following: 1) Cover page with roundtable/workshop title and list of participants; 2) Overview of the session’s themes, significance, and format, in 100 words or less; 3) Discussion of potential contributions of participants (if not in Overview); 4) One-page CV for each participant. For the filename, please use this nomenclature: “Format, Short Title”.