UAND Annual Meeting Speaker Application
Presenter Name
*
First Name
Last Name
Credentials
(e.g. MHA,RDN,CD)
Presentation Title
*
How will this presentation benefit our members?
Why is this presentation relevant to our members?
What makes you an expert on this topic?
What AV equipment or props would you require?
Schedule preference
*
Day 1 anytime
Day 2 anytime
Day 1 morning
Day 2 morning
Day 1 afternoon
Day 2 afternoon
No preference
For keynote speakers, would you be willing to do a breakout session as well?
Yes
No
Do you have a sponsor?
Yes
No
Note other dietetics/nutrition/food service conferences where you have presented
Can you provide a contact from these conferences if we requested this?
Yes
No
Preferred compensation
Comments
Contact Information
Name
*
First Name
Last Name
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Attach files as applicable:
Resume/vitae/bio
Conflict of interest statement
Overview of presentation with objectives
Other
Browse Files
Cancel
of
Submit
Should be Empty: