Work Stress and Health 2006: Making a Difference in the Workplace - Call for Papers

PRESENTATION PROPOSAL COVER SHEET

Type of Presentation:
_____ Symposium
_____ Paper Only
_____ Poster only
_____ Paper or Poster
_____ Workshop

Length of time requested on program:
Symposium _____50 min. _____90 min.

Workshop _____3 hours _____6 hours

Title of Presentation or Symposium (10 words maximum): ______________________________________________________________________

______________________________________________________________________

Topic (3 selections from Conference Topic List):(1)____(2)____(3)____

Name: ______________________________________________________________________
(First name, Middle initial, Last name, Degree)

_____Presenting Author

_____Symposium Chair (for symposia, please complete entire form for each presenter)

_____Workshop Leader

_____Participant in a symposium or workshop:______Order of Presentation (1-6)

_____Discussant (please note: a discussant is not required, and in the case of a symposium, a discussant may or may not be the chairperson)

_____Corresponding Author (responsible for all communication with APA, and in the case of symposia and workshops, responsible for dissemination of all APA information to symposia and workshop participants)

Institution/Organization: ______________________________________________________________________

Complete Mailing Address: ______________________________________________________________________

______________________________________________________________________
(City, State/Province, Zip, Country)

Email: _________________________________FAX:____________________________

Telephone numbers: Office:____________________Home:___________________________

Please check your professional area:
_____ Administration
_____ Research
_____ Service Organization
_____ Advocacy
_____ Public Policy
_____ Education
_____ Consumer Services
_____ Other______________

Please check your professional discipline:
_____ Consumer
_____ EAP Specialist
_____ Epidemiologist
_____ Higher Education
_____ Labor Affiliated Professional
_____ Lawyer
_____ Management Specialist
_____ Nurse
_____ Occupational Medicine
_____ Physician (specify)___________________
_____ Policymaker
_____ Psychiatrist
_____ Psychologist
_____ Public Health Specialist
_____ Social Worker
_____ Other (specify)_______________________

Please check your primary affiliation:
_____ Government Agency
_____ Hospital/Heath Care Industry
_____ Labor Organization
_____ Nonprofit Organization
_____ Private Industry
_____ Private Practice
_____ Public Health Agency
_____ University
_____ Other (please specify) ______________


Additional Authors: List the names, degrees, addresses, and disciplines for ALL authors and indicate who will present, if any. If no list is enclosed, we will assume that the Presenting Author or Corresponding Author is the only author.

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________


Audiovisual Equipment Needed:

_____ 35mm slide projector
_____ Overhead projector
_____ Powerpoint

Notification:

_____ I have enclosed two stamped, self-addressed envelopes
_____ I prefer to be notified via email: ____________________

Enclosure checklist:
_____ Presentation Proposal Cover Sheet (one for each presenter)
_____ 2 copies of full abstract for each presenter
_____ 5 copies of anonymous abstract for each presenter
_____ 2 self-addressed, stamped envelopes (if necessary)

If submitting a symposium or workshop, also include:
_____ Presentation Proposal Cover Sheet (one for each participant)
_____ 2 copies of full symposium or workshop summary abstract
_____ 5 copies of anonymous symposium summary abstract


Direct submission and all conference-related questions to:

Wesley Baker
Conference Coordinator
American Psychological Association
Women's Programs Office
750 First Street, NE
Washington, DC 20002-4242
Phone: 202-336-6033
FAX: 202-336-6117
Email