Please Read Submission NBCC Requirements.

Continuing Education:
Please be aware that any proposal submitted will need to meet criteria for Continuing Education credits (unless you specifically request that it not be listed for CEs). 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. First Name Last Name (Presenter)

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* 2. If your presentation has multiple speakers, please list them here:
Full Name and Credentials

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* 3. Credentials

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* 4. Degree

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* 5. Agency/Organization

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* 6. Emailing Address

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* 7. Preferred Phone

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* 8. Are you a published author?

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* 9. Presenter Bio

PDF, DOCX, DOC file types only.
Choose File
No file chosen

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* 10. Presenter Photo

JPEG, JPG file types only.
Choose File
No file chosen

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* 11. Presenter Vitae/Resume

PDF, DOCX, DOC file types only.
Choose File
No file chosen

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* 12. Title of Presentation

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

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* 14. Goal and Objective One

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* 15. Goal and Objective Two

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* 16. Goal and Objective Three

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* 17. Length of Presentation

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* 18. Green Cross Track Trauma Proposal

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* 19. Presentation day preference

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

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* 21. 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 2019 FMHCA Annual Conference 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.


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