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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?
*
One person
Two people
Three people
Four people
Five people
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
*
Eastern
Central
Mountain
Pacific
Asian time zones
European time zones
Other time zones
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
*
Eastern
Central
Mountain
Pacific
Asian time zones
European time zones
Other time zones
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
*
Eastern
Central
Mountain
Pacific
Asian time zones
European time zones
Other time zones
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
*
Eastern
Central
Mountain
Pacific
Asian time zones
European time zones
Other time zones
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
*
Eastern
Central
Mountain
Pacific
Asian time zones
European time zones
Other time zones
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
*
Eastern
Central
Mountain
Pacific
Asian time zones
European time zones
Other time zones
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".
Phone
Submit
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