Proposal Submission Form (2 pages)

Submit all information as you wish to see it published.

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* 1. What is your title?

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* 2. Contact Information

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* 3. Will you have a co-presenter?

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* 4. Have you provided a service or presented at a PHRA event in the past?

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* 5. If yes (you have provided a service or presented at a PHRA event in the past) please explain:

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