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* 1. Name

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* 2. Email Address

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* 3. Phone Number

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* 4. Education

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* 5. Certification/Licensure

 
CADC
LCADC
LAC/LPC
LSW/LCSW
PhD/PsyD

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* 6. Bio/CV/Resume (copy and paste info)

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* 7. Title of Presentation

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* 8. Description of Presentation (250 words or less)

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* 9. Objectives 3-5 (3 minimum)

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* 10. References (minimum # of 5 references within the last five years)

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