2027 AMTA Call For Speakers Application

2027 AMTA Call For Speakers Application

All applications must be complete when submitted. Incomplete applications may not be reviewed or considered for presentation.
SPEAKER INFORMATION
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
AMTA MEMBER ID
If you are an AMTA member, are you a chapter volunteer?

YesNo

SPEAKER BIO*
30-50 words that highlight your qualifications to teach this session.
COURSE DESCRIPTION*
Include a two to three sentence description for your session to be used in promotional material (this may be edited by AMTA).
RELEVANCE OF COURSE*
Briefly explain why the course is relevant to massage therapy. Please be as detailed as possible.
SCHEDULE OF COURSE*
Provide a detailed outline indicating the number of hours or minutes spent teaching each topic.
SAMPLE HANDOUT OR POWERPOINT PRESENTATION*

AMTA requires a handout or PowerPoint Presentation for attendees who take Convention classes. Example: infographics, outline of core concepts, technique descriptions or detailed notes pages.
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CLASS NEEDS - What materials will attendees be required to bring with them?*

Massage TableYoga Mat or BlanketNo materials needed
LEARNING OBJECTIVES - List objectives in measurable terms that are attainable and can be evaluated. Objectives must be relevant to the practice of massage therapy.*

BIBLIOGRAPHY - List research citations that support the content presented that have been completed in the last five years.*
PRESENTATIONS - Please list any presentations done within the last three (3 years). Identify dates and locations.*
CHECKLIST FOR CE APPROVAL - NCBTMB and state massage therapy boards require submission of a copy of AMTA National Convention speakers’ diplomas, degrees, licenses, or certificates. AMTA will submit all courses for continuing education credit to the NCBTMB and state licensing boards.

CV or Resume (Required)Copy of undergraduate, graduate or any advanced degree diplomaCopy of health care provider license, massage, chiropractic, medical, etc.Copy of certificate of completion of massage school/programCheck here if you hold a BCTMB or NCBTMB approved provider certificate. AMTA will verify with NCBTMB.Other
If applicable, list current professional certifications.
Include certification name, number and expiration date. (e.g., BCTMB, CST, NMT, etc.).
EDUCATION*
CV or Resume*

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Diploma or Massage Completion Certificate

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Health care provider license, massage, chiropractic, medical, etc.*

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AUDIO VISUAL INFORMATION
Because of the size of Convention and expected class capacity, each room will be provided:
- one wireless lavaliere microphone
- one LCD projector with screen
- one riser if session is hands-on with table
All presenters must furnish their own laptop. AMTA is unable to provide laptops, massage tables/chairs, linens or oils/lotions for presenters or participants. No audio visual or room set changes will be made on site.

By checking this box, the submitter agrees to bring their own laptop to Convention and will use the allotted audio visual equipment in their classroom.
I agree to bring my own laptop to present at Convention and I will use the allotted audio visual equipment in the classroom.*

YesNo
COURSE RECORDING
If the format of your course is lecture or hands-on without table and you've been selected to present, your session may be recorded. It is possible this video will be turned into an online CE course that will be housed on the AMTA learning management system as part of the AMTA online course portfolio. Please confirm it is OK to record your session.*

Yes, I approve recording my session.No, please do not record my session.N/A - my course format preference is a hands-on with table session

SPEAKER DISCLOSURE FORM
The American Massage Therapy Association (AMTA) is committed to ensuring an objective and unbiased presentation of all its professional education activities.

With this in mind, we ask all presenters to disclose any
- actual,
- potential, or
- perceived
- vested interests that may have been a direct or indirect influence on the subject matter being presented.
It is not the intent of this declaration to prevent a speaker with potential vested interest from making an educational presentation where continuing education hours are awarded. However, making such information available to the attendees will assist them in forming their own judgment about the content presented.

Disclosure should include any relationship that may bias the speaker's presentation or which, if known, could give the perception of bias. Such relationships may include, but are not limited to:
- a non-paying or paying position of influence such as an officer, board member, trustee, or public spokesperson for a non-profit or for-profit association or entity
- consulting fees or other remuneration (payment) such as employment
- Royalties or other remuneration (payment) or recognition from authoring, co-authoring or collaborating on a book of any kind, video or for any content where the presenter receives royalties.
- any in-kind benefits or services
- ownership or partnership
- research grants
- speakers bureau
- stock options or bond holdings in a for-profit corporation or self-directed pension plan
DISCLOSURE*

I declare that I have an interest or affiliation with an organization that might be perceived as a real or apparent conflict of interest. I authorize the disclosure of this existence (i.e., the organization and the type of relationship) in materials related to the educational event.I have no relationships to disclose.
If a relationship exists, please list the name of the organization and identify the potential conflict by type of relationship (see above for examples). The list of speakers who have disclosed relationships will be included in the materials associated with the educational event. This list will include the nature of the relationship and the associated organization.

I hereby attest that the information in this application is true to the best of my knowledge. (Required)*

I hereby attest that the information in this application is true to the best of my knowledge. (Required)
Signature*
Date*

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Date
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2027 AMTA Call For Speakers Application

SPEAKER INFORMATION

COURSE INFORMATION

AUDIO VISUAL INFORMATION

COURSE RECORDING

SPEAKER DISCLOSURE FORM