Presenter Proposal Form 2016

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1st Speaker*

First Name *:
Last Name *:
Speaker Title:
Company *:
Department:
Address *:
City *:
State/Province *:
Country *:
Zip/Postal Code *:
e-mail:
Phone Number *:
Url:

*(Note: The first speaker contact will receive all correspondance)

Second Speaker Section
2nd Speaker
- First Name:
- Last Name:
- Speaker Title:
- Company:
- Department:
- Address:
- City:
- State/Province:
- Country *:
- Zip/Postal Code:
- e-mail:
- Phone Number:
- Url:
Third Speaker Section
Third Speaker
- First Name:
- Last Name:
- Speaker Title:
- Company:
- Department:
- Address:
- City:
- State/Province:
- Country *:
- Zip/Postal Code:
- e-mail:
- Phone Number:
- Url:
Fourth Speaker Section
Fourth Speaker
- First Name:
- Last Name:
- Speaker Title:
- Company:
- Department:
- Address:
- City:
- State/Province:
- Country *:
- Zip/Postal Code:
- e-mail:
- Phone Number:
- Url:
Fifth Speaker Section
Fifth Speaker
- First Name:
- Last Name:
- Speaker Title:
- Company:
- Department:
- Address:
- City:
- State/Province:
- Country *:
- Zip/Postal Code:
- e-mail:
- Phone Number:
- Url:

Title of Proposal* (120 characters maximum - about 18 words)

Proposal Title:

Length of Session*

General Conference: 1-hr general conference 2-hr general conference | Pre-Conference: 3-hr pre-conference 5-6 hr pre-conference

Type of Presentation*

Lecture Lab

Presentation Summary* (350 characters maximum - about 48 words)
Presentation Abstract* (1000 characters maximum - about 180 words)

Enter 3 keypoints attendees will learn at your presentation * (110 characters maximum for each)

Key Point 1 *:
Key Point 2 *:
Key Point 3 *:

Expertise Level *

Beginner Intermediate Advanced All Levels

Disability Areas* (Check all that apply)

If other, specify:

Topic Areas * (Check all that apply)

A/V & Computer Equipment Needed for Presentation†

TV/DVD Player Wireless Internet Flip Chart

Windows PC

(We encourage presenters to bring their own laptop)

†(A screen, lcd projector and wireless Internet are provided in each room).

For hands-on workshops only: equipment, software and setup required†

If other, specify:

†(all lab PCs have an Internet connection, Firefox, Office & Internet Explorer)

Maximum class size:
Number of additional proctors needed (from conference staff):

If you have not presented at AHG previously, please list some conferences that you have presented at in the last year or two.

Past Presentations
Date	Conference	Title or topic of presentation
date of conference 1	name of conference 1	Title of presentation 1
date of conference 2	name of conference 2	Title of presentation 2
date of conference 3	name of conference 3	Title of presentation 3

Speaker 1 bio (1000 characters maximum)
Speaker 2 bio (1000 characters maximum)
Speaker 3 bio (1000 characters maximum)
Speaker 4 bio (1000 characters maximum)
Speaker 5 bio (1000 characters maximum)

Presentation Paper or Hand-Outs

Please include a 2 to 5 page paper of your presentation in electronic format with your proposal. As an alternate to the paper, presenters can submit a PowerPoint outline (electronic version) of their presentation and/or other handouts, prior to the conference. If a paper is not submitted with this proposal, the speaker is committing to either the submission of a paper at a later date or electronic handouts to be sent by October 1, 2016.

First Round of Submissions

Please return this proposal form by April 22 for the first round of submissions. Speakers will be notified by May 30 confirming acceptance or decline of their proposal(s).

Second Round of Submissions

If there are remaining presentation slots, a second round of proposals will be announced. Speakers will be notified by June 1 if there is a second round RFP.

Please note that due to a limited amount of time slots, some proposals may not be accepted. Proposals submitted during round one are given preferred consideration for speaker slots.

Speaker Agreement

Please note the following:

The proposal, paper, and any handouts speakers provide may appear on our website and other media as part of marketing for the conference. Conference handouts and links to presenter's e-mail addresses will also be posted on the post-conference website. Please submit an electronic copy of your handouts by October 1 either through e-mail: ahg@ahead.org or by mailing a CD or DVD to the address below.
Handouts, including alternate formats (Braille, Large Print, Disk, posting on Web) are the responsibility of the presenter(s). The number of registered attendees requiring alternate formats will be sent to presenters by October 10th. Please let us know if you need assistance in providing your material in alternate format.
It is understood that permission has been given by program presenters for audio-taping, video-taping and photographs. Audio of the sessions may appear on the post-conference website. Tapes/videos/DVDs may also be made of the sessions and provided to attendees during the conference for a fee. Pending speaker consent, some conference sessions may be streamed to off-site audiences. Other video material may be used for fee-generating post-conference events. Speakers who consent to use of their material for fee-generating post-conference events will receive compensation in the form of access to our video library or other compensation to be determined.
A 10% discount on registration fees will be provided to presenters who are traveling to the conference from out-of-state. Local presenters who present for one session or more receive a 5% discount off conference fees.
Pre-conference presenters who present 6 hours or more will receive additional discounts. Contact ahg@ahead.org or 303-492-8672 for specifics.

Please indicate your acceptance of the above agreement by typing in your name below in lieu of signature:

Presenter 1: Type your name to indicate agreement with above stipulations
Presenter 2: Type your name to indicate agreement with above stipulations
Presenter 3: Type your name to indicate agreement with above stipulations
Presenter 4: Type your name to indicate agreement with above stipulations
Presenter 5: Type your name to indicate agreement with above stipulations

Will you be sending your paper in a subsequent e-mail to AHG Conference after you submit this proposal?* Yes No

*(Papers not sent with proposal must be submitted by Oct. 1)
Do you consent to the audio recording of your conference sessions according to the stipulations listed above. Yes No
Do you consent to the video recording of your conference sessions according to the stipulations listed above.* Yes No
Do you consent to the video streaming of your conference sessions according to the stipulations listed above.* Yes No

*(Consent for taping and streaming are not required for proposal acceptance)

Important: if you do not receive a confirmation message with a proposal id number, your proposal has not been submitted. Look for error messages above if you do not receive confirmation!

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