Speaker Interest Submission | Connecticut Academy of PAs

Upon clicking the Submit button below, your form and any files you attached will be sent to the ConnAPA office. You will receive a confirmation of receipt within 1-2 business days at the email address you provided. If we have any questions about the information, we will contact you. Further correspondence from you can be sent directly to: connapa@ssmgt.com

For reference, conference content generally follows the NCCPA PANRE Blueprint.

Thank you for your interest in participating in the continuing education of PAs and other healthcare providers.

Speaker Form

Name*
First Last
Title/Degree*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Speciality
Employer
Job Title
Topic/Title of Presentation*
Learning Objectives*
Please submit a minimum of 3 objectives
Short Description of session to use in programming*
Brief Bio*
Could you please let us know if you have any relevant disclosures to make, such as financial relationships, affiliations, or other interests that might be pertinent to your participation as a speaker at this event?
Headshot (Please do not submit webcam or self portraits.
Accepted file types: jpg, png, Max. file size: 200 MB.
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Phone
This field is for validation purposes and should be left unchanged.