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Submission Form

2025 - Panel Submission

2025 - Panel Submission

Panel Organizer Information

Panel Organizer First Name *

Example: John
Please do not include prefix, suffix, or title

Panel Organizer Last Name *

Example: Smith
Please do not include prefix, suffix, or title

Panel Organizer Email *

Panel Organizer Affiliation *

Panel Organizer Current Position *

Academic

Non-Academic

Not affiliated with an organization

OtherOther

Academic Position * Academic Position

Non-Academic Position * Non-Academic Position

Does this panel have a co-organizer? *

Yes

No

Panel Co-Organizer Information

Panel Co-Organizer First Name *

Example: John
Please do not include prefix, suffix, or title

Panel Co-Organizer Last Name *

Example: Smith
Please do not include prefix, suffix, or title

Panel Co-Organizer Email *

Panel Co-Organizer Affiliation *

Panel Co-Organizer Current Position *

Academic

Non-Academic

Not affiliated with an organization

OtherOther

Academic Position * Academic Position

Non-Academic Position * Non-Academic Position

Panel Details

Describe here the panel overall, which may include the significance of the topic, the goals of the panel overall, and how the proposed presenters/talks fit together. You will be asked to list each panelist and briefly describe their proposed talk, in more detail, below.

Panel Title *

Panel Description - Please note: The description typed here is what will appear in the program, should the session be selected. *

This Panel applies to the following categories (check as many as apply): *

Community Engagement

Patient Centered Outcome Research

Social Sciences (Sociology, psychology, economics, political science, geography)

Medical Sciences (Medicine, microbiology, toxicology)

Public Health (Epidemiology, community health)

Public Policy (Public policy, policy analysis, urban planning)

Allied Health (Nursing, Social Work, Dentistry)

Humanities (Anthropology, history, critical theory, feminist theory, ethics, philosophy)

Law, Management, Architecture, Art, Music

Environmental Health

OtherOther

Presenter Details

Please list each panelist and describe the talk that each panelist/presenter will give.

Presenter First Name *

Example: John
Please do not include prefix, suffix, or title

Presenter Last Name *

Example: Smith
Please do not include prefix, suffix, or title

Presenter Email *

Presenter Affiliation *

Presenter Talk Title *

Presenter Talk Description (500 character limit) *

I confirm this presenter has been contacted and I confirmed their willingness to participate in this session. *

Yes

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CONTACT US:

Suzanne Bevan
Executive Director
PO Box 1831
Eagle, Idaho 83616
sbevan@iaphs.org

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