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Presentation proposal submission form
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Presentation proposal submission form
Please don't fill out this input box.
Primary Presenter Information
Full name
*
Include their first and last name.
Organization
*
Job title
*
Email address
*
Phone number
*
Twitter handle
Presenter bio
*
(150 word maximum)
Proposal information
Session topic
*
Community
Education
Business
Health & Wellness
Type of presentation
*
Academic Paper
Panel Discussion
Workshop
Student Poster Session
Title
*
(10 word maximum)
Abstract
*
(150 words maximum)
Co-presenter information
Will there be a co-presenter?
*
Yes
No
Complete the following section only if you have a
co-presenter
:
Full name
Include their first and last name.
Organization
Job title
Email address
Twitter handle
Co-presenter bio
(150 words max)
Commentator information
Will there be a commentator?
*
Yes
No
Complete the following section only if you have a
commentator
:
Full name
Include their first and last name.
Organization
Job title
Email address
Phone number
Twitter handle
Commentator bio
(150 words maximum)
Panelist(s)
Complete the following section(s) only if you are submitting a
panel discussion
:
Panelist 1 information
Full name
Include their first and last name.
Organization
Job title
Email address
Phone number
Twitter handle
Panelist bio
(150 words maximum)
Panelist 2 information
Full name
Include their first and last name.
Organization
Job title
Email address
Phone number
Twitter handle
Panelist bio
(150 words maximum)
Panelist 3 information
Full name
Include their first and last name.
Organization
Job title
Email address
Phone number
Twitter handle
Panelist bio
Panelist 4 information
Full name
Include their first and last name.
Organization
Job title
Email address
Phone number
Twitter handle
Panelist bio
(150 words maximum)
End of panelist(s) section
Moderator information
Full name
Include their first and last name.
Organization
Job title
Email address
Phone number
Twitter handle
Moderator bio
(150 words maximum)
Optional survey questions
The following
optional
questions are asked in an effort to track our progress in increasing diversity and inclusion at our events. This information will
not
be shared.
What gender does the primary speaker identify with?
Please Select
Woman
Man
Other gender identity
Prefer not to answer
Does the primary speaker identify as a person of color?
Please Select
Yes
No
Prefer not to answer
What racial/ethnic background does the primary speaker identify with?
Asian
Black
Hispanic/Latino
Indigenous Peoples
Pacific Islander
Self-Identify
Prefer not to answer
(select all that apply)
If you chose self-identify in the previous question, please share the racial/ethnic background you identify with.
Does the primary speaker identify with any other underrepresented groups?
(disability, LGBTQ+, etc.)
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