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Emerging Speakers Program Application Form
Applicant Information
*
1.
Full name
(Required.)
2.
Credentials
*
3.
Email
(Required.)
*
4.
Employer/practice
(Required.)
5.
Length of time in practice
Less than 2 years
2-5 years
6-10 years
More than 10 years
6.
Which Conference will you attend?
SVN Annual Conference
APP Program at SVN Annual Conference
Speaking Background and Goals
7.
Previous presentation experience
None
Unit or department level
Local or regional
National
Please describe experience
8.
Please describe professional and presentation goals (up to 100 words)
9.
Preferred presentation format
Poster
7-minute podium presentation
Not sure yet
10.
Topic idea (if you have one)
Uploads and Personal Statement
*
11.
Why do you want to participate in the Emerging Speakers Program? (up to 250 words)
(Required.)
*
12.
Please upload your CV
(Required.)
Choose File
No file chosen
Commitment Acknowledgment
*
13.
I understand that if selected, I will:
• Attend three live virtual education sessions at 6:00 p.m. ET, or watch the recordings if I can’t attend live: Tuesday, January 12; Tuesday, February 16; and Tuesday, March 23, 2027
• Meet with my mentor for three one-on-one sessions
• Attend the June 2027 conference and give a poster or 7-minute oral presentation in the Emerging Speakers session
(Required.)
I agree
