MHCA will use the answers gathered from this survey to consider potential presenters for our Annual Convention (in person, end of September each year) and our Spring Virtual Conference (end of April each year).

Sessions should be submitted in 1.5 hour segments. Multi-session proposals are welcome.

Videos submitted will only be reviewed when accompanied by the proposed presentation information requested.

ALL SESSION INFORMATION MUST BE SUBMITTED TO BE CONSIDERED.

Annual Convention (Sept.) speaker selection is typically complete by May 31; Spring Virtual Conference (April) speaker selection will typically be completed by January 15.

If you have any questions, please email Rhonda Simmons, Education, Events & Membership Specialist at admin@mthealthcare.org.

Question Title

1. Full name and preferred or nickname

Question Title

3. Business Address (travel expense reimbursement check to be mailed here)

Question Title

4. Work or primary contact phone number (not cell)

Question Title

5. Cell phone number (if we may call you regarding initial inquiries) (Required.)

Question Title

6. Provide a text version of your bio for our review (or attach a doc, pdf or jpg below)

Question Title

7. Upload a copy of your bio for our review here (in doc, jpg, or pdf format)

Question Title

8. Please upload your CV (curriculum vitae) (in doc, pdf or jpg)

Question Title

9. Please upload a photograph of yourself (not required for consideration; preferred format: pdf, jpg or png).

Question Title

10. Please provide links to your social media accounts for our review.

Paste links in the comment box below to your LinkedIn account, Facebook, Instagram, company or individual website, etc.

Question Title

11. Speaker Fees

Please describe your speaker fee structure. Let us know what you typical charge for each 60-90 minute session, and what we would expect if we were to use you for 2-3 sessions per convention. We prefer to use a speaker for multiple sessions, but will consider single sessions.

Question Title

12. References

Please list other groups you have provided presentations to. We are particularly interested in other long-term care associations you have presented to.

For each, provide the association/company, name of contact, and their email and phone number.

Question Title

13. Other Information:

Please provide other information you think would be relevant to our decision.

Question Title

14. Please upload documents (speaker offering lists), videos, and other relevant items you feel might assist with our consideration.

Uploaded documents will not stand in lieu of the requested information but is intended to supplement it.

Multiple files may be uploaded.

Please provide information for your proposed presentations on the next pages. Three pages have been provided. More may be submitted by uploading a document with the relevant information requested.

Question Title

15. Proposed Presentation 1: Brief Title

Please provide a succinct title, typically 5-10 words long

Question Title

16. Proposed Presentation 1: Detailed Description

Please provide a description of Proposed Presentation #1 in one or two paragraphs

Question Title

17. Proposed Presentation 1: Please list at least three learner objectives from this presentation in measurable, behavioral terms (using at least 1 measurable verb per objective).

Question Title

18. Proposed Presentation 1: Please state the target facility types this will be relevant to:

Question Title

19. Proposed Presentation 1: What are the target disciplines of your presentation?

Educational offerings may be intended for the interdisciplinary team or particular disciplines. Please select all that your offering is intended to be relevant and beneficial for.

T