Application to Speak at AS & Technology Conference

General Information

 
Please complete this form if you would like to be considered to be a speaker at the AANE/Aspire spring conference on technology.

Although this form asks about a single person with AS, you may also choose to discuss the impact of a specific technology on multiple individuals with AS (for example, yourself and your child, multiple children, multiple students or clients).
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1. Name
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2. Street Address
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3. City
4. Country
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5. Email Address
6. Telephone Number
7. Is the above number your:
8. Website or Personal Blog
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9. Will you be available to speak at the conference in Newton, MA on Friday, March 15, 2013?
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10. What is your relationship to the person with AS who uses the technology?
11. If you work with the person with AS in a professional capacity, what is your profession?
Please be as specific as possible.
12. How old is the person with AS?
13. What is the name of the technology you will be speaking about?
14. Link to applicable website:
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15. Briefly describe what the technology does, and when and how it is used.
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16. Briefly describe the challenges the person with AS was experiencing prior to using the technology.
(Please include only challenges addressed by the technology.)
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17. How has the technology helped the person overcome challenges related to his or her AS?
18. How has the technology improved the person's quality of life overall?
19. Is there anything else we should know about this technology?
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20. Do you have a financial interest in this technology?
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21. Describe any experience you have had with public speaking.
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