Activate 2018 Presenter Proposal Survey

Question Title

* 1. Please provide contact details to be used on our website and in our Activate 2018 Brochure and Program.

Name *

Title *

Company

E-Mail Address

Website

Question Title

* 2. Are you able to provide us with a picture of yourself to be used on our website? *If so, please email photo katie@agsafe.org

yes

Question Title

* 3. Please provide a brief biography of yourself to be used on our website and conference app in promotion of the conference.

Question Title

* 4. Please provide preferred contact details to be used to contact you before, during and after the 2018 AgSafe Conference. This information is to remain confidential.

Office Phone Number

Cellular Phone Number

E-Mail

Address

City/Town

State/Province

ZIP/Postal Code

Question Title

* 5. Please provide emergency contact information. This information is to remain confidential.

Name

Cellular Phone Number

Question Title

* 6. Are you interested in presenting more than one topic at Activate 2018?

Yes

Question Title

* 7. Please provide session title:

Question Title

* 8. How long is your presentation?

60 minutes

75 minutes

Question Title

* 9. Please provide session description and learning objectives in 100 words or less. *If you need more space please email your description and objectives to katie@agsafe.org

Question Title

* 10. How will you use technology, hands on activities, resources, and/or tools to make your presentation more interactive?

Question Title

* 11. Is this a panel presentation?

Yes

Please provide the Name, Organization, and email of your fellow presenters.

Question Title

* 12. Will your presentation contain a video or another type of audio file?

Yes

Question Title

* 13. Will you be requiring a microphone?

Yes

Question Title

* 14. If applicable, please provide a title for your second session.

Question Title

* 15. If applicable, please provide second session description and learning objectives in 100 words or less. *If you need more space please email your description and objectives to katie@agsafe.org

Question Title

* 16. If applicable, will your second presentation contain a video or another type of audio file? Will you need a microphone?

Yes

Please specify

Question Title

* 17.
2018 AgSafe Conference Speaker Agreement

-I agree to comply with all program related deadlines provided to me by AgSafe, including but not limited to deadlines for presentation, handouts, etc.
-During my presentation I will not disparage AgSafe in any way.
-I agree to notify AgSafe's program manager immediately in the event that an emergency should prevent me from meeting my obligation as a presenter.
-I agree to use the PowerPoint templates provided to me by AgSafe, and I agree not to use the template in any way except in connection with the AgSafe Conference.
-To the best of my knowledge, my presentation does not violate any proprietary or personal rights of others (including any copyright, trademark and privacy rights), is factually accurate, and contains nothing defamatory or otherwise unlawful. I have the full authority to enter into this agreement and have obtained all necessary permissions or licenses from any individuals or organizations whose material is included or used in my presentation.
-I authorize AgSafe to use my name, likeness, photograph, and biographical data in connection with the use and promotion of the conference.
- I agree to have a locked PDF version of my presentation made available on the AgSafe website after the conference and to conference attendees, in either locked PDF version or hard copy, during the conference.

By initialing below you agree to the above terms and conditions.