Clone of UAND Speaker Application

UAND Southern Utah Conference Speaker Application
Theme: Elevating Dietetics Practice
Date: November 12, 2026
Location: Holiday Inn St. George Convention Center, St. George UT
Presenter Name

First NameLast Name
Credentials
e.g. MHA, RDN, CD
Email Address
example@example.com
Presentation Title
Please select the topic(s) most relevant to your presentation:

Other
Learning Objectives

Submit 2-3 Performance Indicators that you feel best fit the scope of your presentation. (Select green "+" to add more fields or red "-" to delete fields, as necessary.)

Review the CDR Essential Practice Competencies to find approved Performance Indicators.

Ex: 6.3.1 Accurately and ethically shares research findings with a variety of audiences.
Enter Performance Indicators below:
What experience do you have related to your presentation topic?
How does your presentation relate to the theme for this year's annual meeting?
What do you expect participants to take away from your presentation?
What is your scheduling preference?
What AV equipment, props, or other needs do you require?
Do you have a sponsor?
Sponsor Organization
Sponsor Contact

First NameLast Name
Sponsor Email Address
example@example.com
Compensation

Selected speakers will receive a $200 honorarium and free registration for the conference, unless sponsorsed by a partnering organization.
Please note, you must submit a Resume/CV and Conflict of Interest form (if applicable) for EACH presenter or panelist in your proposed session.
Do you have any conflicts of interest?
A statement of disclosure is required. You may submit your own disclosure or you may use the CDR template.
Conflict of Interest Disclosure

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Resume/Curriculum Vitae

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Please note, due to updated CDR requirements, all speakers selected to present at the Southern Utah Conference will need to submit a bibliography of supporting materials for their presentation. If selected, this bibliography must be submitted within one week of selection.
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UAND Southern Utah Conference Speaker Application