2021 Clinic Session Title Form

January 27-30, 2021

Tan-Tar-A Conference Center

Name (MMEA board member submitting information.)*
Clinic Presentation for (MMEA Area)*
Clinician Information
Clinician Name*
First Last
Please enter clinician name exactly as it should appear in MMEA Conference publications.
School or Company Affiliation

(If Applicable)
Clinician Email
Clinic Session Information
Title of Clinic/Session*

Please enter the proposed TITLE of the clinic/session as of this deadline.
Clinic/Session Topic
If available, please include a brief overview of the proposed CONTENT of the clinic/session to be presented.
Preferred Day/Date of Clinic Session

Clinician Information