PQRI Focused Workshop Proposal Online Submission Form

PQRI Focused Workshop Proposal Online Submission Form

Submission Form will not be accepted for consideration unless all requested information is completed.
Submission Form without a tentative program agenda WILL NOT BE CONSIDERED by the Steering Committee.

Chair (Required)
* Name:
* Company:
* Address:
* City, State, Zip:
* Country:
* Phone:
* Fax:
* E-Mail:
* Field of Expertise:

Co-Chairs
Name:
Company:
Address:
City, State, Zip:
Country:
Phone:
Fax:
E-Mail:
Field of Expertise:

Name:
Company:
Address:
City, State, Zip:
Country:
Phone:
Fax:
E-Mail:
Field of Expertise:

*Proposed Workshop Topic/Title:

*Thought Leaders Who Should Participate in Workshop:
*Goals and Objectives of Workshop:
*Describe the importance and timeliness of the proposed topic/theme and how the workshop will support PQRI’s objectives.

*Previous and/or known planned related workshops on this topic/theme with when/where they took place/will take place, and explain how this workshop will relate to them. What will be unique or novel about the proposed workshop?
*Describe workshop preparation stating how the organizing committee will help participants prepare for discussions and interactive participation in the workshop. What materials will be made available in advance, and how will the organizing committee ensure the inclusion of differing perspectives and an overall balance of views on the topic/theme.

*What format will the workshop take?	General Session for entire workshop General Session with breakout sessions*If there are breakout sessions, will they be used for discussion only or will there be scheduled presentations? Specify when breakout sessions would occur (each afternoon, second day only, etc.) **Number of breakout session rooms required Concurrent Sessions throughout workshop (no general session) Other (Please Specify)

*Will there be any type of proceedings done after the workshop?	Yes No
White Paper	Where would this be published?
Book

Attach a tentative program agenda to this document for consideration.Email the completed MS Word document or fax a copy of the completed MS Word or PDF document to:PQRI Secretariat Fax: (202) 842-8465 (Please address to the attention of PQRI Secretariat – c/o Dede Godstrey)