Third Annual Teen Pregnancy Prevention Conference

Thank you for your interest in presenting at the OAH, ACYF/FYSB, and CDC/DRH Third Annual Teenage Pregnancy Prevention Conference. All abstracts will be peer-reviewed by a panel of reviewers.

Please complete the required information on the abstract submission form below by October 15, 2012 to be considered for this year’s conference. Please note: only two presenters per abstract will be accepted.

(* Denotes Required Field)

Abstract information
Abstract Title (10 words limit):	*
Track:	*
Topic:	*
Learning Objective 1:	*
Learning Objective 2:
Learning Objective 3:
Intended Audience(s):	Program directors/managers Evaluators Tier 1 A/B Tier 1 C/D Tier 2 PREIS CDC grantees School-based programs Community-based programs Clinic-based programs Direct-staff/facilitators Intermediate staff member (less than 5 years of experience) Advanced staff member (5 or more years of experience)
Proposal Type:	*
Abstract Content (500 words limit):	*

Lead Presenter’s information
First Name:	*
Middle Name:
Last Name:	*
Degrees:	A.A.B.S.N.D.S.W.M.A.M.H.S.M.S.W. A.B.B.S.W.Dr.P.H.M.B.A.M.P.A.N.D. A.S.D.D.S.Ed.D.M.D.M.P.H.Ph.D. B.A.D.Min.J.D.M.Div.M.S.Psy.D. B.A.S.D.O.L.L.B.M.Ed.M.S.N.Sc.D. B.S.D.Sc.L.L.M.M.H.A.M.S.S.W.Other B.Sc.
Are you an OAH, ACYF or CDC Grantee?	*
Lead Presenter’s Affiliation:	*
Address: (Street or FedEx Address)	*
Room/Suite/Floor:
City:	*
State:	*
Zip:	* -
Daytime Phone:	* Ext.
Cell Phone:	Ext.
Fax:
Email:	*
Biography (200 words limit):	*
Will you have a co-presenter?	*