Supported Life Institute Conference 2017
SESSION PRESENTER APPLICATION

To be considered for a session, please submit your application no later than March 31, 2017.

1.
*Session Title
(8 words or less)
2.
Lead Presenter Information
 
*First Name

*Last Name


 
Affiliation
(if any)
 
*Street Address
 
*City
 
*State/Province
 
*Zip/Postal Code
 
Phone (Day)
 
Phone (Eve)
 
*Email
 
Are you a:


If Other, please explain:

3.
*General topic area:


If Other, please specify:

4.
*Which conference days are you available to present?
 
5.
If there are other presenters, please provide for each:
    Co-Presenter Names/Affiliations
Email address
Note whether co-presenter is a:
Family member?
Person with a disability?
Professional? (or "Other" - explain)
 
6.
*Session Summary (50-100 words):
 
7.
*Brief Resume/Bio/Personal History of Lead Presenter
(up to 100 words):
 

8.

Session Objectives: Please give us three one-sentence descriptions of things an attendee will learn from your session. Sample Objective: "Attendees will learn 5 principles of self-determination"

(This will be used to help the planning team in evaluating your session for acceptance)

 
*Objective #1:
 
*Objective #2:
 
*Objective #3:
     

*Required

†Make sure that your email address is correct. We will email you a receipt confirmation that includes a copy of your proposal for your records.

Please check that your information is correct and press "Submit Application" (below)

Cancel this Application