1. Contact information
- Name
- Credentials
- Email
- Phone number
- Address
- Institution
- Years out of practice (or resident/fellow)
2. Your biography. Please provide a brief summary of your education, work history, and experience, not to exceed 200 words.
3. Title of your PhyzTalk story. This title will be listed in all promotional materials and programs.
4. Your PhyzTalk story. Include a detailed description or summary of the story you’d like to present, not to exceed 500 words.
4. Have you presented before? Please provide a list or summary of your past presentation experience, including whether you have presented on this topic. (Note: past presentation experience is not required).
5. How do you think your story could impact physiatrists or the physiatrist community? What is your take-home message?
6. At this time, do you anticipate being able to travel to New Orleans for the in-person Annual Assembly? All faculty are expected to be in-person for the 2024 Annual Assembly in San Diego. This session will be live-streamed out to virtual participants.
7. Are there any special considerations the reviewers should be aware of? Would your presentation have any special A/V, or other technical or logistical support needs?
8. Any other comments on why you should be selected?