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2015 Presentation Proposals
Please complete this form for a presentation proposal. For questions contact Marilyn Neault and Lydia Gregoret at
neci.sturbridge@gmail.com
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Authors (List primary presenter first):
Name Badge Example:
JANET
Janet Smith, Au.D.
Holy Tympanum Hospital
Brooklyn, NY
Primary Presenter (Speaker)
First Name:
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Your answer
Last Name:
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Your answer
Degree/Certification:
Your answer
Institutional Affiliation - Name:
Your answer
Institutional Affiliation - City, State:
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Number of Presenters (including Primary Presenter):
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