2021 Call for Presentations Submission Form Question Title * 1. Tell us about yourself. Primary Presenter Title/Position Organization Address City State Zip Phone Email OK Question Title * 2. Secondary Presenter Secondary Presenter Secondary Title/Position Secondary Organization Secondary Address Secondary City Secondary State Secondary Zip Secondary Phone Secondary Email OK Question Title * 3. Are you a current member of the Home Care Association of New York State? Yes No OK Question Title * 4. If you are not a member would you like information on becoming a member? Yes No Not Applicable OK Question Title * 5. Presentation Topic: OK Question Title * 6. Presentation Title: OK Question Title * 7. Presentation description (abstract) OK Question Title * 8. Presentation Learning Objectives OK Question Title * 9. Upload biographical sketch for primary presenter. PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Upload biographical sketch for primary presenter. OK Question Title * 10. Upload biographical sketch of secondary presenter (if applicable). PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Upload biographical sketch of secondary presenter (if applicable). OK Question Title * 11. Has this program been presented previously? Yes No OK Question Title * 12. Will your presentation include handout materials? Yes No OK Question Title * 13. Who is your target audience? Select all that apply Executive Leadership Management Finance Human Resources Operations Clinicians Paraprofessionals Other (please specify) OK Question Title * 14. For which of the following do you wish this proposed presentation to be considered? Check all that applyNote: Proposals for a signature event must be received at least 8 weeks prior to the date of the targeted event. Virtual Annual Conference (May 5 & 6, 2021) - Attended by executives, administrators, managers and directors of all service lines. (60 - 75 minute sessions) Senior Financial Managers Retreat (September 9 & 10, 2021) - Attended by home health finance directors, CEOs and CFOs (60 - 75 minute sessions) Corporate Compliance Symposium (October 20, 2021) - Attended by CEOs, CFOs, VPs, administrators, directors of compliance and patient services, etc. (60 minute sessions) NE Home Health Leadership Summit (Jan 2022) - Co-hosted by the state associations of NJ, NY, MA, CT, NH, VT, RI and ME. Attended by home care and hospice executives from throughout the host states. Standalone full or half-day program (single session or series) - Date, location and length to be mutually determined. Webinar (single session or series) - provided throughout the year on informative topics (60 - 90 minutes) Other (please detail) OK Question Title * 15. What is the ideal length of time required for presentation (including Q&A) 60 Minutes 75 Minutes 90 Minutes Half Day (3 - 4 Hours) Full Day (6 Hours) Multi-Day Other (please specify) OK Question Title * 16. Have additional supporting documents or multiple presentation proposals? Please upload your supplemental document here. PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Have additional supporting documents or multiple presentation proposals? Please upload your supplemental document here. OK Question Title * 17. Do you require a speaker's fee? Yes No OK Question Title * 18. Please provide us with your speaker's fee. OK DONE
