Application Form PIA 2023 Breakout Session

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Application Form PIA 2023 Breakout Session

The Phoebe Institute on Aging (PIA) conferences educate health professionals and caregivers about current needs and front-line solutions for older adults and their caregivers. The PIA provides forums for discussion and learning, including educational programs, cooperative ventures, and outreach activities designed to promote improved quality of life and care for the aging and their families.

Please be sure to read and review the Application Instructions before proceeding with the form below.

Spring 2023 PIA Conference Breakout Session Proposals

To apply to be a presenter at the 2023 PIA Conference, please fill out the form below. A * designates a required field. Located at the bottom of the form there is an option to Save and Return if you need additional time to complete your application. Thank You!

Title of Presentation*
Presenter Name*
Presenter Title*
Organization Representing*
Address*
Office Phone*
Cell Phone*
Email Address*
One-Page Biography or Vita*
Accepted file types: pdf, doc, docx, wps, Max. file size: 16 MB.
Please upload a maximum one-age biography or vita. This document will be submitted with Continuing Education Unit (CEU) applications.
Short Biography*
Provide a 50 to 100 word professional biography to be used in promotional materials.
Breakout Session Description*
Please write a concise description, 50 to 100 words, about the presentation. Emphasize subtopics and/or issues that will be presented. Identify what participants can expect as a result of the presentation. This description will be the basis of text used in promotional materials and applications for Continuing Education Units (CEUs).
Breakout Session Learning Objectives*
What do you want the audience to learn? Please list at least three (3) learning objectives, being as specific as possible. Learning objectives must relate to the conference objectives. This information will be used in the CEU applications.
Breakout Session Format*
Please note there will be a virtual component to breakout sessions. Please check all that are applicable. Hold down the Ctrl button to select more than one option.
Breakout Session Audiovisual Needs*
Please note that your Power Point presentation will be pre-loaded to the conference center computers by event staff. We would need to know if there is video and sound in the presentation. You should also bring your Power Point presentation on a flash drive as a back-up. Hold down the Ctrl button to select more than one option.
Do you give PIA permission to post your PowerPoint presentation or recorded presentation (if applies) on phoebe.org or Phoebe’s YouTube space in order for attendees to access them after the conference?*
- Yes
- No

Save and Continue Later

Thank you for your interest in presenting at the 2023 Phoebe Institute on Aging Conference!

If you have questions or would like a PDF version of the application form, please email [email protected] or call 610-794-5132.

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