2010 Call for Presenters Submission Form
Submission Deadline - March 31, 2010

 Name:    Credentials: 

Title:    

Company / Organization: 

Address:

City: State: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NY NC ND OH OK OR PA OR RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone: Fax:   E-Mail:  

Website:

Please provide a one paragraph narrative about each person participating in the presentation

Session Information

Session Title:   Session Length: 60 Min. 90 Min.

Session Description:

in 200 words or less please give a give a short description of your session. NOTE: if this application is accepted, NAHCA publications will include the following text (subject to editing)

Session Objective:

List three learning objectives by completing the statement "At the conclusion of this session, the participant should be able to:" NOTE: if this application is accepted, NAHCA publications will include the following objectives (subject to editing)

 1.

2. 

3. 

Speaking History

Identify your experience in making presentations to groups:

   Significant Experience     Moderate Experience      Limited Experience

References:

   I have spoken at a previous NAHCA event: 

                           Event:  Event Date:

                           Title of Presentation:

  I will be a new speaker for NAHCA. List a recent speaking engagement and respective contact / reference

                           Contact Person:   Title:

                           Company:    Phone:

                           Event:    Event Date:

                           Title of Presentation:  

Compensation

My organization will sponsor the session therefore NAHCA will not incur any cost for me to speak

• Please note that NAHCA will offer all presenters a complementary registration into the NAHCA Annual Convention and Trade Show in lieu of honorarium and/or expenses

I will need an honorarium of

I will need reimbursement for the following incidental expenses with an estimated cost of

  Air Travel    Ground Travel (ie. rental car and / or mileage) Overnight accommodations Meal per diem

Availability

Wednesday, June 2    Thursday, June 3

If you are not available to speak in Oklahoma City, Oklahoma. on June 2 or 3, 2010, please do not submit an application.  The speaker selection process will be completed by April 15, 2010.

Co-Presenters

I will present alone    I will have a co-presenter

Name:        Credentials:

Company:         Phone:

Presenter applications must be received no later than March 31, 2010. Submit online or by e-mail to:

dpaniak@nahcacares.org