Call For Proposals Form

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Session Title

Session Title(Required)

Lead Presenter

Lead Presenter Photo(Required)

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

Name(Required)

First Last

Credentials(Required)

List credentials in the following sequence: permanent credentials (educational degrees), professional licenses, national certifications, and then additional certifications.

Company/Institution(Required)

Position/Title(s)(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Mobile Phone

Instagram

Facebook

X/Twitter

Email(Required)

Website URL

Professional Experience(Required)

Please provide a short bio (1,000 character limit)

Financial Disclosure

Presenters are required to disclose whether or not they have relevant financial relationship(s) or, relevant non fictional relationship(s), and must list anything that could be interpreted as making you bias on the presentation content. TIP: All employed speakers will have at least one financial relationship to disclose (i.e., salary from employment).

Does this presenter have any relationships necessary to disclose?(Required)

Yes

No

Financial Disclosure Details(Required)

Additional Presenters

Please note, you may submit up to three additional co-presenters using this form. If you have additional co-presenters, please email Megan Turek (mturek@closingthegap.com) with their full contact details and photo.

How many additional presenters will there be?(Required)

Additional Presenter 1

Photo(Required)

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

First & Last Name(Required)

Credentials(Required)

List credentials in the following sequence: permanent credentials (educational degrees), professional licenses, national certifications, and then additional certifications.

Company(Required)

Position/Title(Required)

Email(Required)

Phone(Required)

Mailing Address(Required)

Address, City, State, Zip, Country

Instagram

Facebook

X/Twitter

Professional Experience(Required)

Please provide a short bio (1,000 character limit)

Financial Disclosure

Presenters are required to disclose whether or not they have relevant financial relationship(s) or, relevant non fictional relationship(s), and must list anything that could be interpreted as making you bias on the presentation content. TIP: All employed speakers will have at least one financial relationship to disclose (i.e., salary from employment).

Does this presenter have any relationships necessary to disclose?(Required)

Yes

No

Financial and Non-Financial Disclosure Details(Required)

Additional Presenter 2

Photo(Required)

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

First and Last Name(Required)

Credentials(Required)

List credentials in the following sequence: permanent credentials (educational degrees), professional licenses, national certifications, and then additional certifications.

Company(Required)

Position/Title(Required)

Email(Required)

Phone(Required)

Mailing Address(Required)

Address, City, State, Zip, Country

Instagram

Facebook

X/Twitter

Professional Experience(Required)

Please provide a short bio (1,000 character limit)

Financial Disclosure

Presenters are required to disclose whether or not they have relevant financial relationship(s) or, relevant non fictional relationship(s), and must list anything that could be interpreted as making you bias on the presentation content. TIP: All employed speakers will have at least one financial relationship to disclose (i.e., salary from employment).

Does this presenter have any financial relationships necessary to disclose?(Required)

Yes

No

Financial and Non-Financial Disclosure Details(Required)

Additional Presenter 3

Photo(Required)

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

First and Last Name(Required)

Credentials(Required)

List credentials in the following sequence: permanent credentials (educational degrees), professional licenses, national certifications, and then additional certifications.

Company(Required)

Position(Required)

Email(Required)

Phone(Required)

Mailing Address(Required)

Address, City, State, Zip, Country

Instagram

Facebook

X/Twitter

Professional Experience(Required)

Please provide a short bio (1,000 character limit)

Financial Disclosure

Presenters are required to disclose whether or not they have relevant financial relationship(s) or, relevant non fictional relationship(s), and must list anything that could be interpreted as making you bias on the presentation content. TIP: All employed speakers will have at least one financial relationship to disclose (i.e., salary from employment).

Does this presenter have any relationships necessary to disclose?(Required)

Yes

No

Financial and Non-Financial Disclosure Details(Required)

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Name

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Section Break

Session Title

Lead Presenter

Financial Disclosure

Financial Disclosure

Additional Presenters

Additional Presenter 1

Financial Disclosure

Additional Presenter 2

Financial Disclosure

Additional Presenter 3

Financial Disclosure

Session Details

Type of Session

Session Details

Equipment and Audio / Visual

Presentation Software & Captioning

Learning Outcomes

Professional Development

Abstract

Session Summary

CEU QUESTIONS

CEU QUESTION 1

CEU QUESTIONS 1 (MULTIPLE CHOICE OPTIONS)

CEU QUESTION 2

CEU QUESTIONS 2 (MULTIPLE CHOICE OPTIONS)

CEU QUESTION 3

CEU QUESTIONS 3 (MULTIPLE CHOICE OPTIONS)