test2 – AHVMA

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Company

Instructions

This form must be completed in one sitting; entries cannot be saved for later editing.

In addition to basic information about yourself, the following is REQUIRED to complete this form:

Your CV in .doc or .pdf format
Brief biography of 150 words or less
A high-resolution photo of you for use in promotional materials
Titles, abstracts, and objectives for each lecture
RACE letters of recommendation, if available (applies only to some candidates)

Please verify: *

I have all of the required documents, and I am prepared to complete this form in one sitting.

Contact Information

First Name *

Last Name *

Complete Mailing Address: *

Is this your home or work address? *

Primary Phone: *

Cell Phone: *

Email: *

Credentials

Veterinary Degree *

Year *

School *

Other Degrees

Board Certified? *

If yes, list specialties:

Other Professional Certifications and Accreditations

Are you an AHVMA member? *

Are you an AVMA member? *

Other Current Professional Associations

Professional Employment *

Beginning with most recent.

Professional Publications

Past 5 years only.

Published Books

If applicable.

Professional Interests

Professional Consultant Positions

List all current and past.

Please upload your FULL CV: *

.doc or .pdf format only

Biography

Please submit a brief biography, which will be used to introduce you before each of your lectures. *

150 words / 750 characters max.

Photo

Please upload a high resolution photo of yourself that is suitable for inclusion in promotional materials (e.g. the conference program). *

.jpg, .tif, or .png format

Lecture Proposals

How many lectures are you submitting today? *

Lecture 1 Title: *

50 characters max.

Abstract: *

250 words / 1250 characters max.

Objective 1: *

One sentence that describes what the audience will learn from your lecture.

Objective 2: *

One sentence that describes what the audience will learn from your lecture.

RACE Letters of Recommendation

RACE requires two (2) letters of recommendation for some speakers.

If any of the first four statements below apply to you, you will not need to submit recommendations.

Please select all that apply: *

I am board certified or completing a residency in my subject matter.

I hold a PhD or comparable degree in my subject matter, or I am in the process of earning one.

I am on the faculty of an AVMA- or CVMA- accredited college of veterinary medicine or animal health technology, instructing in my subject.

I have published one or more papers on my subject matter in a peer-reviewed scientific journal within the last 5 years.

NONE of the above apply to me. I will need to submit 2 letters of recommendation, either now or before the conference.

RACE Letter Upload

You may submit your letters below. If you are unable to do so now, we will request them at a later date.

See the RACE Letter of Recommendation Template as a guide.

Recommendation Letter 1:

.doc or .pdf format

Recommendation Letter 2:

.doc or .pdf format

I have reviewed my proposal and the information I have provided is true and accurate to the best of my knowledge. I understand that incomplete submissions will not be reviewed.

I also understand that the AHVMA will not contact me about my application unless I am selected to speak at the Conference.

By submitting this form, I understand that the AHVMA will store and use my information for the purposes of notifying me if I have been selected to present at the conference, and if so, for the purposes of advertising and promoting my conference lectures.