Call for Speakers - Louisiana Pharmacists Association

Call for Speakers

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The Louisiana Pharmacists Association is "Calling for Speakers!" If you are interested in presenting a continuing education activity at an LPA function, please complete the following form. (Please review LPA's honorarium policy here.)

First Name *		Last Name *
Email Address *
Cell Phone		Daytime Phone
Address Line 1
City		Country
Location		Zip/Postal Code
Place of Employment
Professional Title (i.e., RPh, PharmD)		Title / Position at Company
Topic / Title to Present *
Contact Hours		Target Audience *
What educational need will this presentation fill? *
Activity Description and/or Learning Objectives
Do you have a potential Conflict of Interest?	Yes No Not Sure
Preferred Presentation Time	Any Annual Conference Virtual CE
Additional Comments:
If Virtual CE, please indicate Month(s)	March April May September October November December

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