FACCM & APPLE 2027 Conference Breakout Speaker Proposal Form

FACCM & APPLE 2027 Conference Breakout Speaker Proposal Form

Conference Theme: GROW. LEAD. SUCCEED.
June 25-26, 2027

Hilton Orlando - 6001 Destination Pkwy, Orlando, FL 32819
Presenter Information
Presenter Full Name
Organization Name
Presenter Title/Position
Email Address
example@example.com
Cell Phone Number (Internal use only in case we need to get in touch with you during the conference)
Please enter a valid phone number.Format: (000) 000-0000.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
LinkedIn URL
Please Provide a Brief Bio (100-150 words)
Please Upload a Professional Headshot

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What Day(s) Are You Available to Present?
Are You Co-Presenting? (if yes please enter Presenter 2's information below)
Presenter 2 Full Name
Presenter 2 Organization Name
Presenter 2 Title/Position
Presenter 2 Email Address
example@example.com
Presenter 2 Cell Phone Number (Internal use only in case we need to get in touch with you during the conference)
Please enter a valid phone number.Format: (000) 000-0000.
Presenter 2 LinkedIn URL
Presenter 2 Please Provide a Brief Bio (100-150 words)
Presenter 2 Upload a Professional Headshot

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Session Information
Session Title
Presentation Description (100 words or less)
Target Audience (please check all that apply)

Other
Which of the Following Conference Tracks Does Your Presentation Best Fit Within?
Statement of Need for this Session
Learning Outcomes

Please provide a minimum of 3 definitive, specific, and measurable outcomes for your session. We ask for this information so that participants can earn CEUs by attending your presentation. Learning objectives are a prerequisite for earning CEUs.

An example of a learning outcome: By the end of this session, participants will be able to identify key principles of developmentally appropriate practice in early childhood education and describe how they support children’s cognitive, social, and emotional growth.
Please list your learning outcomes below
Intellectual Property and Proprietary Interest (please list any proprietary products, instruments, devices, services, and materials developed, published, or have ownership in for sale related to the session)
Additional Information
Are you willing to give your presentation multiple times during the conference? (we will reach out to you if we feel this is needed)
Next Steps

Our conference committee will review your proposal and let you know if you have been selected to present, along with the date and time of your presentation.
Please read and sign below before submitting
Intellectual property and proprietary interest disclosure statement:

FACCM respects the intellectual property rights and interests of each presenter in connection with the design and delivery of all materials provided and presented for purposes of inclusion in this workshop. Please further note that FACCM will not copy, rebroadcast, or otherwise reproduce any submitted materials in which an instructor holds intellectual property rights or interest, without written instructor approval. During the presentation, presenters are prohibited from selling products, instructions, devices, services, or materials. FACCM requires the disclosure of any third-party sponsors of the presentation. Please note that all such intellectual property rights and proprietary interests must be disclosed to learners prior to the start of the conference.

Non-discrimination disclosure statement:

FACCM is committed to providing an inclusive and welcoming environment for all members of our staff, clients, continuing education participants, volunteers,
subcontractors, vendors, and clients. FACCM does not and shall not discriminate based on race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring, and firing of staff, selection of volunteers, instructors, and vendors, and provision of services.

If approved, the undersigned agrees to present the presentation described above under the umbrella of FACCM, Inc., an IACET accredited provider, according to the documentation submitted herein.
By submitting this proposal, I understand that if selected:
- I agree to present at the time assigned
- I will provide any digital or physical materials used during the presentation to the FACCM and APPLE Accreditation staff in advance of the conference as requested
- This is an unpaid speaking opportunity
- I will be asked to pay a discounted conference registration fee
- I will cover my own travel and lodging unless otherwise agreed
- I will represent FACCM and APPLE Accreditation in a professional manner
Signature
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FACCM & APPLE 2027 Conference Breakout Speaker Proposal Form

June 25-26, 2027

Presenter Information

Session Information

Additional Information

Next Steps

Please read and sign below before submitting