Speaker Agreement

Program Organizer Information

Program Organizer Full Name(Required)

Program Organizer Degrees(Required)

Program Organizer Affiliation(Required)

Organization/university/company

Program Organizer Email(Required)

Is the program organizer the same as the program presenter?(Required)

Yes

Presenter Information

If the program organizer is different from the presenter, please fill out this section.

Presenter Full Name

Presenter Degrees

Presenter Affiliation

Organization/university/company

Presenter Email Address

Program Information

Please indicate the program you are presenting.(Required)

Presentation Title(Required)

Presentation Duration(Required)

Please share a brief description and overall purpose of this educational session that will entice your audience to attend and set realistic expectations of the content.(Required)

This will be used to help market the program.

Please list up to three learning objectives or takeaways.(Required)

These are statements that communicate what attendees can expect to learn during the program.

Educational Level of Program(Required)

General interest

Intermediate

Advanced

Please list additional presenters, including their full contact information, including degrees, affiliations and emails.

Presenters should reflect practice trends from around the world (geographically diverse) and provide attendees with various perspectives about the same subject. If there are not any additional presenters, you can leave this field blank.

If presenting a half or full day workshop, please upload an agenda or outline of the program.

Max. file size: 63 MB.

This will be used for marketing.

Moderator Information

Will the program be moderated?(Required)

Moderator Full Name

Moderator Degrees

Moderator Email

Moderator Affiliation

Organization/university/company