South Florida Association of Christian Counselors Event Proposal Form

Question Title

* 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 Event

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* 3. Proposed length of event:

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* 4. Brief Description of Event (written to attract mental health professionals)

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* 5. List 3-4 Learning Objectives

Objective 1

Objective 2

Objective 3

Objective 4

Objective 5 (Optional)

Objective 6 (Optional)

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* 6. Preferred Date(s)/Time(s)

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* 7. Brief Bio of Presenter (used to introduce the presenter and to promote the event):

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

PNG, JPG, JPEG, GIF file types only.

Choose File

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

PDF, DOCX, DOC file types only.

Choose File

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* 10. TERMS

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

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 SFACC. SFACC 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.

South Florida Association of Christian Counselors Event Proposal Form

Question Title

* 1. Address

Question Title

* 2. Title of Event

Question Title

* 3. Proposed length of event:

Question Title

* 4. Brief Description of Event (written to attract mental health professionals)

Question Title

* 5. List 3-4 Learning Objectives

Question Title

* 6. Preferred Date(s)/Time(s)

Question Title

* 7. Brief Bio of Presenter (used to introduce the presenter and to promote the event):

Question Title

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

Question Title

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

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* 11. By affixing my initials below, I am attesting to my agreement with the above terms.

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* 12. Printed Name:

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* 13. Date Signed: