LOEX 2021 Breakout Proposal Submission Form

* Required Information

Name*

First Name

Initial (optional)

Last Name

Job Position/Title*

Institution/Organization*

City*

State*

Country

Email Address*

Use an address you check often

Phone*

Number of Presenters*

------- If applicable, please fill in the below fields about the 2nd and 3rd presenters -------

2nd Presenter Name

2nd Presenter Title

2nd Presenter Institution/Organization

2nd Presenter Email

3rd Presenter Name

3rd Presenter Title

3rd Presenter Institution

3rd Presenter Email

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Session Description

Session Title (limit to 20 words)*

Session Track: Select One that Fits Best*

Session Abstract (limit 100 words)*

This is *both* for the LOEX Proposal Review Committee and for conference attendees.

Long Proposal Description (limit 500 words)*

This long proposal text will only be used by the conference committee for proposal evaluation; it is not for attendees.

Learning Outcomes (at least one, but no more than three). Participants will...*

Type of Audience(s) for your session (select at least one)*

Brand new to the topic At least some experience with the topic

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Have any of you given this presentation (or a similar presentation) elsewhere in the last three years?*

Yes No

If yes, where and when?

Have any of the presenters presented at LOEX in the last five years?*

Yes No

If yes, where and when?