IEPA 2021 Symposia Submission Form

We are delighted to have you chair and/or present at IEPA's upcoming virtual conference IEPA 2021 Virtual. Please provide us with some information about you and your symposium so that we can promote your symposium in the lead up to the event. These details will also be visible to delegates on the conference platform. Please provide all information in English.

Preferred Title of Symposium Chair*

Name of Symposium Chair*

First Last

Symposium Chair's Primary Organisation / Affiliation*

City and Country Chair will be in at the time of the conference*

Chair's Email Address*

Please provide an email address that the conference organisers can contact you on. This will NOT be visible to delegates

Symposium Chair's Phone Number*

Please provide a phone number that the conference organisers can contact you on. This will NOT be visible to delegates.

Symposium Chair Bio*

Please provide a 250 word Bio that we can display on our website and promotional materials

Chair Photo (Headshot)*

Please provide a high quality headshot in .jpg file format. You may provide more than one image. The maximum file size is 64MB

Drop files here or

Accepted file types: jpg, jpeg, Max. file size: 64 MB, Max. files: 3.

Title of Your Symposium*

Please provide the title of your presentation - no more than 25 words

Summary / Overview of Symposium*

Please provide a 250 word summary of your sympsium that we can display on our website and promotional materials

Primary Theme*

Please select a theme for your symposium. Your symposium will be attached to this theme in the conference program

Name of Presenter 1*

First Last

Presenter 1 Primary Organisation / Affiliation*

City and Country Presenter 1 will be in at the time of the conference*

Presenter 1 Email Address*

Please provide an email address that the conference organisers can contact Presenter 1 on. This will NOT be visible to delegates

Presenter 1 Bio*

Please provide a 250 word Bio that we can display on our website and promotional materials

Presenter 1 Photo (Headshot)*

Please provide a high quality headshot in .jpg file format. You may provide more than one image. The maximum file size is 64MB

Accepted file types: jpg, jpeg, Max. file size: 64 MB.

Title of Presentation 1*

Please provide the title of your presentation - no more than 25 words

Presentation 1 Abstract*

Please provide a 250 word abstract that we can display on our website and promotional materials

Name of Presenter 2*

First Last

Presenter 2 Primary Organisation / Affiliation*

City and Country Presenter 2 will be in at the time of the conference*

Presenter 2 Email Address*

Please provide an email address that the conference organisers can contact Presenter 2 on. This will NOT be visible to delegates

Presenter 2 Bio*

Please provide a 250 word Bio that we can display on our website and promotional materials

Presenter 2 Photo (Headshot)*

Please provide a high quality headshot in .jpg file format. You may provide more than one image. The maximum file size is 64MB

Drop files here or

Accepted file types: jpg, jpeg, Max. file size: 64 MB, Max. files: 3.

Title of Presentation 2*

Please provide the title of your presentation - no more than 25 words

Presentation 2 Abstract*

Please provide a 250 abstract that we can display on our website and promotional materials

Name of Presenter 3*

First Last

Presenter 3 Primary Organisation / Affiliation*

City and Country Presenter 3 will be in at the time of the conference*

Presenter 3 Email Address*

Please provide an email address that the conference organisers can contact Presenter 1 on. This will NOT be visible to delegates

Presenter 3 Bio*

Please provide a 250 word Bio that we can display on our website and promotional materials

Presenter 3 Photo (Headshot)*

Please provide a high quality headshot in .jpg file format. You may provide more than one image. The maximum file size is 64MB

Drop files here or

Accepted file types: jpg, jpeg, Max. file size: 64 MB, Max. files: 3.

Title of Presentation 3*

Please provide the title of your presentation - no more than 25 words

Presentation 3 Abstract*

Please provide a 250 abstract that we can display on our website and promotional materials

Name of Presenter 4*

First Last

Presenter 4 Primary Organisation / Affiliation*

City and Country Presenter 4 will be in at the time of the conference*

Presenter 4 Email Address*

Please provide an email address that the conference organisers can contact Presenter 1 on. This will NOT be visible to delegates

Presenter 4 Bio*

Please provide a 250 word Bio that we can display on our website and promotional materials

Presenter 4 Photo (Headshot)*

Please provide a high quality headshot in .jpg file format. You may provide more than one image. The maximum file size is 64MB

Drop files here or

Accepted file types: jpg, jpeg, Max. file size: 64 MB, Max. files: 3.

Title of Presentation 4*

Please provide the title of your presentation - no more than 25 words

Presentation 4 Abstract*

Please provide a 250 word abstract that we can display on our website and promotional materials

Video Consent*

Your presentation will be recorded and made available for on demand viewing on the event website for 12 months

Agree

Data Processing Consent*

Data Controller: IEPA Early Intervention in Mental Health Association Personal Information: Information provided during your registration to this event is collected and processed under the basis of our legitimate interest to provide you with this educational service. Uses & Sharing: We use your information to process your registration and presentation application and to communicate with you about this event and related events. This scientific meeting is one of identified participants - no anonymous participation is possible. By participating in this event your name and country and/or organisation maybe visible to other attendees. We temporarily provide personal information to companies that perform services to us and require them to protect your information in the same way we do. Your Rights: You have the right to receive the information we hold about you, ask to correct it or, under certain circumstances, to delete it. You have the option to unsubscribe from e-mailings on every email you receive from us. If you reside in the EU, you have the right to lodge a complaint with a supervisory authority, in particular in the Member State of your habitual residence, place of work or place of infringement, if you feel that the processing of your personal data infringes the General Data Protection regulation (GDPR). Contact us Any inquiries regarding data protection can be directed to our office at iepa2021@iepaconference.org

Yes

Additional Information

Please let us know if there is anything else we need to know about your symposia session or the presenters that will be participating in your symposium

Name

This field is for validation purposes and should be left unchanged.

IEPA 2021 Symposia Submission Form

IEPA 2021 Virtual Symposia Submission

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