2024 TCCN Annual Conference - Speaker Application
Sep. 3-5, 2024 "Milestones of Hope: 10 Years of Compassionate Care"
Name
First Name
Last Name
Organization
Title
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Have you been a speaker at the TCCN conference previously?
Yes
No
Please briefly share why you're interested in speaking to this audience of free and charitable clinic leaders.
Are you or your organization CURRENTLY a TCCN Partner in Health (formerly Associate Member)? (Partners in Health receive priority consideration for speaking opportunities.)
Yes
No
I'm Not Sure!
Are you or your organization interested in joining TCCN as a Partner in Health (formerly Associate Membership)?
Yes
Maybe - Need More Information
Not at this time
Already a Partner in Health!
Will you have any other co-presenters? If yes, please list.
Preferred Speaking Date:
Wednesday, Sep. 4
Thursday, Sep. 5
No preference
Session Title
Session Abstract - Please list 3 main learning objectives
Session Description - Please describe the content, main points to be covered, relevance to conference attendees, and how the session is unique from others that might address the same topic.
Action Steps - Please list 1 to 3 recommended action steps or takeaways that participants can use at the conclusion of your session.
Presentation Style (Lecture, PowerPoint, Interactive Discussion, Role Play, Panel Discussion, Fireside Chat, Etc.)
TCCN will supply a laptop loaded with your presentation, a projector and screen to display your presentation to the group, and a clicker. Microphones will be provided for Plenary speakers. Please check any additional Audio Visual needs or preferences (cannot be guaranteed):
Sound Capabilities for showing a video clip
Microphone (breakout sessions)
Other
Please provide links to recordings, websites, or other social sites as a reference to your work or experience. (Optional if you've presented at this conference previously.)
Speaker Biography - Enter or Upload
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Compensation Requests (all speakers are invited to join conference attendees for meals and receive parking reimbursement):
1 night's accommodations at the Embassy Suites
Mileage/Travel Reimbursement
Additional travel meals/per diem
Speaker Fee (please list below)
Other
Speaker Fee (if required)
Any other comments, questions or accommodations requested:
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