PAINWeek 2022 Call for Presentations

First Name

Middle Name

Last Name

Additional Degrees

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone

Fax

Professional Status

I am currently in clinical practice

I am no longer in clinical practice

I have an academic appointment

I am currently in clinical practice and have an academic appointment

Other

Public Speaking/Conference Experience

Yes

If you have not presented at PAINWeek before, how many local and regional events were you a speaker in the last 2 years?

Regional

Local

Both regional and local

None

1-4 conferences

5-10 conferences

10 or more conferences

Please list all conferences at which you have presented

Publishing Experience - I have been published in:

Only peer-reviewed journals

Both peer reviewed and non-peer reviewed

I have not been published

Publication in the PAINWeek Journal

Yes

If your course proposal is accepted, would you be interested in adapting your presentation into an article for future publication in the PWJ— PAINWeek Journal?

Course 1

Course Title

Co-Presenter (required if applicable)

Please note that co-presenters must be listed prior to the review and selection process.

Topic Area

Other Topic Area

Complete if you selected other above.

Course 2

Course Title

Co-Presenter (required if applicable)

Please note that co-presenters must be listed prior to the review and selection process.

Topic Area

Other Topic Area

Course 3

Course Title

Co-Presenter (required if applicable)

Please note that co-presenters must be listed prior to the review and selection process.

Topic Area

Other Topic Area

Course 4

Course Title

Other Topic Area

Please note that co-presenters must be listed prior to the review and selection process.

Topic Area

Other Topic Area

Course Descriptions and Learning Objectives

Please submit this information as a Word doc. If submitting multiple course proposals, please include all courses in a single Word document.
One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Submit your CV

One file only.
100 MB limit.
Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

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