Journées dentaires internationales du Québec

1Speaker(s) details

2Conference details

3Material request

Speaker Information

First name*

Last name*

Title abbreviations to indicate on the online program (optional)

Ex: DMD, DDS, M. Sc, FRCD(C), Ph.D, HD

Email address*

Phone number*

Country*

Full address*

City*

State/Province/District*

Postcode*

Is the country and state/province/district the same as those to be entered in the online program?*

Yes

If you selected "no" to the previous question: Country to include on the program

If you selected "no" to the previous question: State/Province/District to include on the program

Speaker biography*

Photo of speaker(s)*

Be sure to name the file name after the speaker's name. A square high-resolution color photo in .jpg format not exceeding 500 KB.

Drop files here or

Accepted file types: jpg, png, jpeg, Max. file size: 5 MB.

Conference information

Date of conference or workshop*

Title of conference or workshop*

A concise title is best. If necessary, it could be adapted for publication purposes.

Synopsis of the conference or workshop and, where applicable, the educational objectives*

Suggested session chair (optional)

If you wish to propose a local session chairman, before submitting his name, you must first obtain his agreement.

First name

Last name

Email address

Phone number

Required equipment, accessories and materials

Please note that any request for a U-shaped room configuration will be considered but is limited by the number of rooms that can accommodate it.

Title of conference or workshop*

Please return to the conference title you provided in Step 2 - Conference Details

Required equipment, accessories and materials

Please note that any request for a U-shaped room configuration will be considered but is limited by the number of rooms that can accommodate it.

Select the hardware you need (optional)

Wireless microphone (lavalier type)

Lectern microphone

Conference easel with colored paper and crayons

Tripod camera (for document)

Power outlets (for workshops)

Lamps (for workshops)

Tablecloths

Table(s) at the back

Table(s) on the side

Chair(s) for the back and side

Specify quantity (wireless microphone)

N/A

Specify the quantity (Tables at the back)

Specify the quantity (Tables on the side)

Specify quantity (Chair(s) for rear and side)

If other, specify

Audiovisual requirements

Please note that an audio link for a laptop and a laser pointer are made available for each presentation. The screen is compatible with presentations in the following formats: 3:1, 4:3 and 16:9. If you have a MAC, please bring your mini display port to VGA or DVI adaptor.

Do you need an internet connection for your presentation?

Yes

Does your presntation include videos?

Does your presentation include audio files?

You are bringing your presentation on :*

What presentation software will you use?

If other, specify

Comfort monitor display (select all that applies to you)

We will supply a wireless slide changer (clicker) If you have speaker notes we recommend bullet points | short text to ensure better visibility in the monitor. You will have a timer displayed on your comfort monitor

Current slide

Next slide

Speaker notes

If other, specify

Special requests and instructions (optional)

Material and equipment for workshops

Please select according your specific needs (optional)

Table lights

Containers for sharp objects

Pig tongues

Pig jaw maxillas

Pig jaw mandibles

Interactive response system (i.e : Slido)

Gloves

N/A

Specify quantity (Pig tongues)

Specify quantity (Pig jaw maxillas)

Specify quantity (Pig jaw mandibles)

N/A

Models supplided by the sponsor or JDIQ

Models supplided by the sponsor or JDIQ?

Sponsor

JDIQ

Type (typodont)

Qty

Company

Motors (subject to availability)

Surgical handpiece

Straight handpiece

Contra-angle style (high speed 1:5)

Latch (slow speed 1:1)

Other

If other, specify

Disposable materials (burs, blades, etc)

Materials and equipment provided by the sponsor

Station de travail

Workstation will be distributed as follows : please check one of the two options.

1 per participant

1 for 2 participants

Total of motors

Matériel et instruments fournis par les participants

Materials and instruments provided by participants

Magnification loupes

Protective glasses

Headlamp

Lab coat

PC or MAC

If other, specify

Information to provide for your conference or workshop

Speaker Information

Conference information

Conference information

Suggested session chair (optional)

Required equipment, accessories and materials

Required equipment, accessories and materials

Audiovisual requirements

Special requests and instructions (optional)

Material and equipment for workshops

Models supplided by the sponsor or JDIQ

Materials and equipment provided by the sponsor

Matériel et instruments fournis par les participants