This form is only to be completed IF you require any AV needs outside of our standard set up of LCD Projector, PC Laptop, microphone, and laser pointer. If you have any questions please contact the office directly at 215-955-2490 or email jeffersoncpd@jefferson.edu. Name: * Please enter your first & last name: Email Address * Select your event: * Please select the course you are speaking at from the menu below. If you event is not listed please select "Other" and enter name of program. Annual Diabetes Symposium Annual Renal Symposium Annual Neurocritical Care Symposium Annual Cerebrovascular Update Annual Heart Disease Symposium Spine Fellows Alumni Symposium Other... Select your event: Other... AV Needs: Please indicate below any special AV requirements/needs we need to be aware of: Leave this field blank