2025 MPCA Annual Conference Speaker Proposal Form
Submissions are due by June 30. For more information please contact info@mepca.org.
Primary Speaker's Name
*
First Name
Last Name
Job Title
*
Company / Organization
*
Degree
Company / Organization Website
*
City
*
State
*
Speaker Phone
*
Format: (000) 000-0000.
Speaker Email
example@example.com
Secondary Contact / Assistant Phone
Format: (000) 000-0000.
Secondary Contact / Assistant Email
example@example.com
Bio for Primary Speaker
*
Is your organization also planning to be an Exhibitor at the Annual Conference?
*
Please Select
Yes
No
Do you have a speaker's fee or honorarium?
*
Please Select
Yes
No
Speaker #2
First Name
Last Name
Email for Speaker #2
example@example.com
Bio for Speaker #2
Speaker #3
First Name
Last Name
Email for Speaker #3
example@example.com
Bio for Speaker #3
Session Information
Title of Session:
*
Abstract. Please provide a clear and concise summary of your presentation’s content.
*
Key Objectives. Please list at least three learning objectives for your session, choosing active verbs and describing specific observable, measurable changes in learners. These are required for CME accreditation.
*
Target Audience
*
Please Select
All Staff
Behavioral Health
Clinical
C-Suite
Dental
Finance
Operations
Other
Policy & Advocacy
Technology
Workforce
If Other, please describe the Target Audience for your presentation.
Have you given this presentation before or do you intend to present it elsewhere in the near future?
*
Please Select
Yes
No
If YES, please list when and where. Feel free to include a link to any video content of previous presentations.
I understand that my presentation would be available on the conference website for attendees to download after the event.
*
Please Select
Yes
No
Signature
Submit
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