Conference Speaker Form

Presentation Information

Title of Presentation(Required)

Program description(Required)

Program Objectives(Required)

Enter 1-3 objectives on separate lines. Click on the + icon for each row.

Track(Required)

Check all that apply.

Long Term Care

Short Stay/Rehab

Assisted Living

Alzheimer's/Dementia

Adult Day Services

Independent Living/Senior Center

Leadership

Other

Track - other

Target Audience(Required)

Check all that apply.

New Activity Professional

Consultant / Educator

Department Director

Activity Assistant

Other

Target Audience - Other

Type of Presentation(Required)

Check all that apply.

Lecture

Panel Discussion

Case Study

Role Playing

Demonstration

Questions and Answers

Other

Presentation - other

Speaker Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone(Required)

Cell Phone(Required)

Email(Required)

Enter Email Confirm Email

Title(Required)

Credentials(Required)

Resume

Max. file size: 255 MB.

Attach a ONE-PAGE resume, or brief vitae, outlining your credentials and relevant experience.

Speaker Bio(Required)

Attach a short introduction about you and the session you will be presenting. The introduction should set the tone of your session. The Session Monitor will utilize this introduction at the beginning of your session. (The introduction is subject to editing by WRAP) No more than 100 WORDS PLEASE.

Session Handouts

If you are unable to submit your handouts at this time, please email them to: RFrize@illuminus.us BY one month prior to conference. These will be made available to conference attendees closer to conference date. Speaker is responsible for bringing handouts if not submitted to WRAP by deadline date.

Session Handouts

Drop files here or

Accepted file types: pdf, Max. file size: 255 MB, Max. files: 5.

References

Drop files here or

Max. file size: 255 MB, Max. files: 2.

A. One state association, college, etc. List dates and places where you have presented sessions or taught the specific session contained in this proposal.
B. One personal reference.

Requested Payment/Compensation

CALL FOR SPEAKERS SUBMISSION FORM:

Presentation Information

Speaker Information

Session Handouts