2027 APA National Conference Speaker Information Form
For assistance with this form, please email FrancesEllington@APAaccess.org.
Name
*
First Name
Last Name
Preferred pronouns
Title/Position
Company/Organization
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social Media Handles/Website
Short Biography (Please keep this to 150 words or less)
Please upload a headshot of yourself. This headshot will be used for the conference webpage, marketing emails, and social media posts. (Recommended Photo Specifications: Resolution: At least 300 DPI (dots per inch) Dimensions: Minimum of 1000 pixels on the shortest side (e.g., 1000x1200 pixels or 1000x1000 pixels square) File Format: JPEG (.jpg) or PNG (.png) File Size: Ideally between 1 MB and 5 MB)
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To help promote future events and showcase the quality of the conference, we intend to take photographs during speaker sessions. These images may be used on APA's website, social media, and in other promotional content. Do you grant permission for your likeness to be captured and utilized in this manner?
Yes
No
Do you have any equipment needs other than a projector? If so, please describe.
Do you have any dietary restrictions? If so, please describe.
Do you have any accessibility needs or requests? If so, please describe.
Will you be seeking CE credit for conference courses other than the one(s) you present? If yes, APA will ask that you register as an attendee.
Yes
No
Please let us know your estimated arrival and departure dates and times for the conference. This helps us with planning.
Is there anything else you'd like to share that will help us with conference planning.
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