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Application to Present a Breakout Session Arlington 2019
This is an application to present a breakout session at the state convention in Arlington, June 20-22, 2019. The deadline is February 15, 2019.
Date of Application *
MM
/
DD
/
YYYY
Title of Breakout Session *
Your answer
Brief Description of Session *
Your answer
Name of Presenter (use the name of the primary presenter responsible for contacting all other presenters) *
Your answer
Chapter *
Your answer
Chapter President? *
Email *
Your answer
Phone (xxx-xxx-xxxx)
Your answer
Presenter’s Credentials *
Your answer
Name of Additional Presenter (if more than 1 presenter)
Your answer
Chapter
Your answer
Chapter President?
Additional Presenter’s Credentials
Your answer
Scheduling Requests or Concerns
Your answer
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