Presenter Application
Presenter Information
Prefix:
Your answer
First Name Last Name (Presenter):
Your answer
If your presentation has multiple speakers, please list them here. Each additional speaker will need to fill out this form in order to be considered
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Credentials:
(Please list any credentials you would like listed after your name in conference materials)
Your answer
Degree:
Your answer
Are you a published author?
Agency/Organization:
Your answer
Emailing Address:
Proposal confirmation and acceptance status will be sent to this address.
Your answer
Preferred Phone
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5. I am a FMHCA member (FMHCA members receive one automatic point in the presentation scoring process. Join now!)
Speaker Bio (800 character max, 2 paragraphs)
Please include credentials, current employer, position/title, and relevant/related experience using complete sentences. Please write in the third person (e.g. Jane Smith, MAC is the Program Director...)
Your answer
Referred By:
2. Please provide the names, email addresses, and phone numbers of two professional references who have attended your trainings.
Your answer
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