2021 Northwest Patient Safety Conference: Extended Call for Posters
October 6 -7th, 2021
8:30 AM - 12:15 PM PST

We are no longer accepting applications for breakout session speakers or presenters. This application is for poster presenters only. Poster presenters may apply from now through September 15th, 2021.

If accepted, conference organizers will contact you to discuss the virtual poster format.

There are two ways to edit your submitted application - 1) Immediately after clicking "submit," a confirmation page with be generated with an option to "edit responses" before confirming submission. 2) An "edit response" link will also be emailed to you with a copy of your responses immediately following your submission. If you do not receive this confirmation email following your submission, please email nlocke@qualityhealth.org.

THIS FORM WILL NOT ALLOW FOR COPY/PASTING INTO THE ANSWER FIELDS - Please type your responses directly into the answer box.  If you have questions or concerns about this form, or would prefer to complete an abstract in hard copy, please contact nlocke@qualityhealth.org.
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Email *
Presentation/Poster Details
The following questions ask about your presentation/poster title, topics, learning objectives, and audience.
Poster Title: *
Poster description: (please limit to 350 words) *
2-3 learning objectives for this poster: *
This poster is best suited for someone who is a(n) *
Presenter Information:
If your presentation requires more than one speaker, please identify a lead speaker. You will be asked to explain the need for additional speakers in a later question.
Lead Presenter Name *
Lead Presenter Job Title *
Lead Presenter Organization *
Lead Presenter Email *
Lead Presenter Phone Number *
Lead Presenter Bio (limit to 175 words) *
Lead Presenter experience or expertise on the presentation topic *
Do you have any relevant relationships or commercial interests to disclose? *
Reference Name *
Reference Email *
Reference Phone Number
Will there be any co-presenters? *
If yes: please list all co-presenters, their email addresses and organizational affiliation, and their experience on the presentation topic.
If yes: Please explain the need for more than one presenter for the poster.
A copy of your responses will be emailed to the address you provided.
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