2026 Addiction Health Summit Conference Event Proposal

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* 1. Address

Presenter Name and Credentials

Company, Agency, or Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Title of conference event/session

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* 3. Proposed length of conference event/session:

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* 4. Description of training:

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* 5. List 3-4 Learning Objectives for the event/session:

Objective 1

Objective 2

Objective 3

Objective 4

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* 6. What is your intended target audience for this webinar?

Introductory (e.g., students, interns, new practitioners)

Intermediate (e.g., independently licensed practitioners)

Advanced (e.g., specialists, experienced practitioners, experts)

Other (please specify)

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* 7. How was the need for the education identified or determined? (Select all that apply)*

Formal needs assessment

Feedback from learners or past activity evaluations

Regulatory Requirement (Updated guidelines, statutory mandate, etc)

Peer-Reviewed Literature Review/Search

Emerging Therapy, Technique, Equipment or Medical Issue (eg: COVID)

Data from Outside Sources (eg: Public health statistics)

Other (please specify)

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* 8. Barriers to Address, Overcome, or Remove:
Examples of barriers include: stigma, lack of time, cost, patient compliance, lack of administrative support. These should reflect barriers from the activity as a whole, not individual sessions or modules. What educational strategies are employed to address, overcome, or remove barriers to change skills, strategies, or performance of the healthcare team?

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* 9. Please provide a change that learners will commit to upon completing the activity.

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* 10. Brief Bio of Presenter (used to introduce the presenter and to promote the webinar, and should include information demonstrating how the presenter is qualified and knowledgeable about the presentation topic):

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* 11. Please upload a headshot photo we can use to promote the webinar (JPG, GIF, or PNG format)

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* 12. Please upload a copy of your resume or CV

TERMS

Payment:
FSAM will credit the presenter appropriately in all promotional materials related to the event/webinar. Presenters shall not be entitled to any reimbursement or honorarium for this event/webinar from any source unless agreed upon in writing with FSAM.

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 permission required for the full performance of Presenter’s obligations under this Agreement and to provide such materials to FSAM. FSAM will be the sole copyright owner of the recorded event/webinar in its entirety. The Presenter grants FSAM an exclusive license right, title, and interest in and to the presentation, including all licenses to copyrights embodied therein for the purpose of the FSAM educational program. FSAM may record the training, provide the recording to attendees, incorporate the training in its "On Demand" training program, and promote the "on demand" version of the training on its website, social media pages, and other organizational platforms.

2026 Addiction Health Summit Conference Event Proposal