All professionals will be charged a registration fee of $150 unless they are either persons with disabilities or parents/guardians of persons with disabilities. Forms must be returned by Friday, January 13, 2017.

If you do not receive a confirmation e-mail within one week of your submission, please send an e-mail to to confirm that we have received your submission.

* 1. Primary Presenter

* 2. Additional Presenter

* 3. Additional Presenter

* 4. Presentation Title

* 5. Language of Presentation

* 6.

Audio/Visual Needs (Lavaliere microphones will be ordered for speakers with accessibility needs only. Please advise if a lavaliere microphone will be needed by calling (888) 309-CAFE. The Family Cafe does not provide projectors.)

* 7. Synopsis - Please attach a brief description of your proposed presentation of approximately 75-100 words, written exactly as you would like it to appear in the official event program. 

* 8. Expertise - Please briefly describe your expertise and/or experience with the topic of your proposed presentation, for consideration by The Family Café Planning Committee in its selection process.