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KHCA/KCAL Speaker Proposal Form
Please complete the following questions:
*
1.
Presenter Name:
(Required.)
2.
Presenter Organization:
3.
Presenter Title:
4.
Email:
5.
Phone Number:
6.
Address:
*
7.
Will you present at (check all that apply):
(Required.)
Conferences – as keynote
Conferences – as breakout session
Independent Educational Program
Online webinar
Other (please specify)
*
8.
Presentation title:
(Required.)
9.
Please select the length of your session
50 Minutes
75 Minutes
90 Minutes
Other (please specify)
*
10.
Presentation description. (This should be written as if an attendee is deciding if they should attend your session.)
(Required.)
*
11.
Presentation learning objectives. (ie at the end of this session the learner will:)
(Required.)
12.
Presenter biography: (for online/printed materials)
*
13.
Please briefly discuss your honorarium request or fee. (presentations requesting fee higher than 5k will not be considered)
(Required.)
14.
Upload your photo (optional, but if selected we will required a photo):
Choose File
No file chosen
