2024 In-Person Conference & Virtual Summit Presenter Application

Deadline to Submit is August 1st, 2023.
Please Read Submission NBCC Requirements.

Continuing Education:

Please be aware that any proposal submitted will need to meet criteria for Continuing Education credits. These criteria are established by professional organizations with whom FMHCA is associated for the purpose of providing CEs to persons attending our workshops and conferences.

•Provide a description, of the content of your presentation, specifying who is teaching each component (if more than one presenter is teaching) and how long each component is expected to take (in minutes).
•Indicate which of your objectives is being addressed for each component.
•If your presentation will include a “group process,” you are still expected to outline the expected flow and time elements of that process. Do not list “group process” and not include the details.

To describe your learning objectives, make statements that indicate what the attendees will be able to do after your presentation.
•Use these terms: list, state, explain, describe, differentiate, discuss, calculate, compare, contrast, choose, define, demonstrate, estimate, evaluate, locate, match, name, plan, predict, rank, recommend, select, summarize, write, etc.
•Do not use these terms: know, learn, appreciate, value, acquire, comprehend, be familiar with, recognize, understand, etc.

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* 1. Name and Credentials

Presenter Name and Credentials

Co-Presenter Name and Credentials

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* 2. Degree

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* 3. Agency/Organization

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* 4. Email Address

Presenter Email

Co-Presenter Email

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* 5. Preferred Phone Number

Presenter Phone Number

Co-Presenter Phone Number

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* 6. Please provide us with links to your social media accounts.

Instagram

Facebook

Twitter

Linked-In

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* 7. Are you a published author?

Yes

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* 8. Presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 9. Co-presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 10. Co-presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 11. Co-presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 12. Presenter Photo

PNG, JPG, JPEG file types only.

Choose File

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* 13. Co-Presenter Photo

PNG, JPG, JPEG file types only.

Choose File

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* 14. Co-Presenter Photo

PNG, JPG, JPEG file types only.

Choose File

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* 15. Co-Presenter Photo

PNG, JPG, JPEG file types only.

Choose File

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* 16. Presenter Vitae/Resume

PDF, DOC, DOCX file types only.

Choose File

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* 17. Co-presenter Vitae/Resume

PDF, DOC, DOCX file types only.

Choose File

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* 18. Co-presenter Vitae/Resume

PDF, DOC, DOCX file types only.

Choose File

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* 19. Co-presenter Vitae/Resume

PDF, DOC, DOCX file types only.

Choose File

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* 20. Title of Presentation

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* 21. Presentation Description (Description will be used in marketing materials, conference program, website, and event app)

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* 22. Goal and Objective One

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* 23. Goal and Objective Two

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* 24. Goal and Objective Three

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* 25. Length of Presentation

2 Hour Session

3 Hour Session

2 Hour Keynote Session

Pre-Conference Workshop (8 hours or more)

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* 26. Green Cross Track Trauma Proposal

Yes, I am submitting a trauma proposal for Green Cross.

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* 27. Presentation day preference

Thursday 02/01/24 Pre-Conference Workshop Only 6 or 8 Hour Session (In-Person)

Thursday 02/01/24 and Friday 02/02/24 Pre-Conference Workshop Only 16 or 12 Hour Session (this option applies only to a two-day pre-conference session) (In-Person)

Friday 02/02/24 Main Conference (In-Person)

Saturday 02/03/24 Main Conference (In-Person)

Would Rather Present Virtually During the Virtual Summit (February or March dates to be determined, after in person conference)

Would be Willing to Present Virtually During the Virtual Summit and In-Person During the In-Person Conference

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* 28. Audio Visual Equipment Required (Presenters must provide laptop and have backup presentation saved to laptop)

LCD Projector and Screen

Microphone

None - I do not require any A/V

N/A Since I prefer to Present Virtually

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* 29. Final Attestation
I have read all the information on this Application to present and agree to abide by the listed terms. I agree if I am selected to present at the 2024 FMHCA Annual Conference or FMHCA 2024 Virtual Summit that the live presentation will correspond with this presentation submission. I will not misuse copywritten material and will use proper citations in all of my presentation materials. Presentation content is limited to factual, educational content that is culturally-sensitive. The proposed presentation will be reviewed by FMHCA and acceptance is not guaranteed.

If accepted, the language submitted in the presentation, including learning objectives, presenters biographies, and session descriptions will be used for marketing purposes. I understand that FMHCA reserves the right to check my professional references. I understand that if I am selected, I will receive a $50 discount on conference registration, but that I am financially responsible for all other travel-related conference expenses, including hotel costs, meals not provided, and any additional conference fees, unless a separate agreement with FMHCA is reached. (Limited scholarships may be available through FMHCA at a later date). By submitting this application to present, I agree to these conditions. A formal speaker’s agreement will be sent to all selected presenters to sign and return to FMHCA.

For Virtual Summit Presenters
Copyright and Ownership:
The Presenter represents and warrants that all presentations are original works created solely by the Presenter, except for public domain material that may be incorporated therein. To the extent that the presentations contain any material or excerpt from the works of others, the Presenter shall ensure that it is done with full right and authority and may be reused as detailed in this Agreement. It is the Presenter’s obligation to obtain all necessary releases, waivers, licenses, and other permits required for the full performance of Presenter’s obligations under this Agreement and to provide such materials to FMHCA. FMHCA will be the sole copyright owner of the recorded webinar in its entirety. The Presenter grants FMHCA an exclusive license right, title, and interest in and to the presentation, including all licenses to copyrights embodied therein for the purpose of the FMHCA webinar educational program. FMHCA may record the webinar, place the recording on FMHCA's YouTube channel, social media pages, and/or website, provide the recording to attendees, and/or incorporate the webinar into its "on demand" webinar program.

Yes, all presenters referenced in this application agree to these terms and conditions

No, all presenters referenced in this application do not agree to these terms and conditions.

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* 1. Name and Credentials

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* 2. Degree

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* 3. Agency/Organization

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* 4. Email Address

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* 5. Preferred Phone Number

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* 6. Please provide us with links to your social media accounts.

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* 7. Are you a published author?

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* 8. Presenter BioPlease include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 9. Co-presenter BioPlease include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 10. Co-presenter BioPlease include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 11. Co-presenter BioPlease include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

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* 12. Presenter Photo

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* 13. Co-Presenter Photo

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* 14. Co-Presenter Photo

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* 15. Co-Presenter Photo

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* 16. Presenter Vitae/Resume

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* 17. Co-presenter Vitae/Resume

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* 18. Co-presenter Vitae/Resume

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* 19. Co-presenter Vitae/Resume

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* 20. Title of Presentation

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* 21. Presentation Description (Description will be used in marketing materials, conference program, website, and event app)

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* 22. Goal and Objective One

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* 23. Goal and Objective Two

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* 24. Goal and Objective Three

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* 25. Length of Presentation

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* 26. Green Cross Track Trauma Proposal

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* 27. Presentation day preference

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* 28. Audio Visual Equipment Required (Presenters must provide laptop and have backup presentation saved to laptop)

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* 8. Presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

* 9. Co-presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

* 10. Co-presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)

* 11. Co-presenter Bio
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, LMHC is the Program Director...) (800 character max, 2 paragraphs)