PRESENTER INFORMATION
Please complete the following information exactly as it should appear in all conference materials including the final brochure and name badges.

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* 1. Primary Contact:

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* 2. Presenter Information:

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* 3. Additional Presenters:

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* 4. Additional Presenters:

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* 5. Additional Presenters:

PRESENTATION INFORMATION
Please complete the following information exactly as it should appear in all conference materials including the final brochure. Description for conference brochure is limited to 500 characters.

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* 6. Title of Presentation

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* 7. Description of Presentation:

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* 8. Please indicate availability for presentation (check all that apply):

Continuing Education Credits for Social Workers, LMHC & CASAC:

If your session’s objectives are pertinent to social workers, please email the following information to nyscaremanagement@gmail.com upon submission of this form:

1. A biographical summary, resume, or CV for each presenter; and

2. Learning Objectives & Pre– and Post-Assessments: In an attempt to gauge how well participants grasp the knowledge they are exposed to in your session, please list three learning objectives and three pre– and post-assessment questions on a separate sheet of paper. Participants will respond to the same question items on the pre– and post-assessments. Each objective should begin with “After completing this session, participants will…” and question types should be either True / False or Multiple Choice (3-4 choices). Please highlight correct answers.

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