Presenter Interest Form
We are currently recruiting for speakers, presenters, panels, training sessions, and workshops to be held during our October 8 & 9, 2019, hosting of the National LOSS Team Conference in Visalia, CA.

The overarching goal of our conference is to educate attendees about postvention efforts as well as to highlight numerous activities of the suicide prevention continuum, including prevention, intervention, care and treatment, and postvention.

The form below should be utilized to nominate yourself, another person, or an agency for participation in our conference. When considering nominating yourself or another, please review our eight tracks to identify the track that your nomination would best relate to. This will help us to balance information and will be utilized in our decision-making process.

We will follow up with submissions on a routine basis.

Tuesday, October 8
7:30 to 8:30 a.m. – Registration
8:30 to 10 a.m. – Welcome & General Session
10 to Noon – Breakout Session 1
Noon to 1 p.m. – Lunch Break
1 to 3 p.m. – Breakout Session 2
3 to 5 p.m. – Breakout Session 3
Evening Events – TBA

Wednesday, October 9
8 to 10 a.m. – Morning General Session (two 45-minute presentations)
10 to Noon – Breakout Session 4
Noon to 1 p.m. – Lunch Break
1 to 3 p.m. – Breakout Session 5
3:00 to 4:30 p.m. – Closing General Session

Presenter's name
Please include any titles or honorifics linked with your name.
Your answer
Presenter's email
Your answer
Presenter's phone number
Your answer
Please specify what type of line the phone is.
Optional: website associated with the presenter
Your answer
Please specify the track the presentation corresponds most closely with.
Presentation title
Your answer
Brief description or overview of the intended presentation
Your answer
Will compensation for the presenter be requested?
This could include speaker fees, travel, materials, etc. Please provide a reasonable level of detail by specifying an activity and the associated cost.
Your answer
Any additional information
Your answer
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