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NCFADS Speaker Information and Topic Proposal
Presenter Contact Information
*
1.
Contact Information
(Required.)
Name
*
Company
Address
*
Address 2
*
City/Town
*
State/Province
*
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
*
Country
*
Email Address
*
Phone Number
*
2.
Listing of Your Nominal Letters (including full title of each). One Per Line.
Example: "LCAS - Licensed Clinical Addictions Specialist"
*
3.
Please Provide a ONE Paragraph Biography (100 Words or Less).
(Required.)
4.
Noteworthy Awards, Recognition, Accomplishments, or Completed Projects/Research?
*
5.
Have You Presented At An NCFADS Summer and/or Winter School Before?
(Required.)
Yes
No
*
6.
Please Indicate the School(s) You Would Like to Present At
(Required.)
Winter School (Late February in Greensboro, NC)
Summer School (Late July in Atlantic Beach, NC)
*
7.
If a virtual option was available, are you interested in presenting an NCFADS session in a virtual platform?
(Required.)
Yes, I have experience and love presenting virtually.
Yes, I am comfortable presenting virtually.
Yes. I have not presented virtually in the past but I am interested in the opportunity and willing to try.
No, I do not wish to present in a virtual platform. My session is best taught in an in-person environment.
*
8.
Please Indicate the TYPE of Proposed Presentation
(Required.)
Mini-Track (3-3.5 Hours)
Main Track (11-15 Hours - Across 3-4 Training Days)
Plenary (1-2 Hours)
Evening Session (2 Hours)
*
9.
Presentation Title (10 Words or Less)
(Required.)
*
10.
Description of Presentation (150 Words or Less)
(Required.)
*
11.
Presentation Objectives
(List at least one measurable objective for each hour of the presentation)
(Required.)
12.
Technology + Multimedia Requirements
Projector
Audio Speakers
Flip Chart + Markers
Loaner Laptop (
using your own laptop is suggested for file compatibility
)
Laser Pointer / Presentation Clicker
Microphone
DVD/Blu-Ray Player
Other (please specify)
13.
OPTIONAL:
How and Why Will Your Presentation Be Relevant, Noteworthy, and Memorable?
14.
Please upload a copy of your resume. (PDF, DOC, DOCX files only.)
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