Thank you for considering becoming a presenter at the Proof Alliance Caregiver Conference on May 18th and 19th, 2023 at the Heritage Center of Brooklyn Center. We anticipate 100 caregivers of individuals with an FASD and are seeking a variety of topics ranging from practical parenting strategies to navigating community services. 

Please complete by January 1, 2023. Presenters will be selected by February 2023. 

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* 1. First and Last Name 

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* 2. Phone number 

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* 3. Email address

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* 4. Organization

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* 5. Organization website 

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* 6. Full mailing address

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* 7. Pronouns 

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* 8. Social Media Handle/s (if applicable)

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* 9. Professional Credentials (B.A., M.D.)

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* 10. Professional Bio (No more than 75 words)

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* 11. Title of Presentation

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* 12. Are you requesting a keynote or breakout session? 

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* 13. In- person or virtual presentation? 

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* 14. Description of Presentation

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* 15. Presentation learning objectives (At least 3)

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* 16. Please provide proposed speakers fee if applicable and clarify amount below. It is helpful is you can break down speaker fee and ballpark travel expenses. *We will do our best to accommodate speaker fees, but cannot guarantee we can meet all requests.

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* 17. Preferred length of time for presentation

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* 18. Do you have co-presenters? If so, please provide name, credentials, and bio.

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* 19. Please provide a headshot you would like to be used in promotional materials

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 20. Please upload your agency logo if applicable. 

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 21. By signing this document, you are agreeing to the terms outlined:
  • I will provide my Microsoft PowerPoint and supporting materials to Proof Alliance by April 17, 2023
  • I agree to have my presentation recorded if applicable for conference participants for a limited time

Please type name and date below.

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