Call for Conference Proposals: EAPA 2019 St. Louis
Please complete this form in its entirety. Please note, this form cannot be saved and returned to (we recommend saving your answers in a word document first). Questions? Contact Julia Barnes, EAPA Education Administrator, at j.barnes@eapassn.org.
Title of Proposed Presentation
*
Maximum 12 Words
Presentation Type
*
Conference Breakout Session (either 60 or 75 minutes)
“EAP Talks” Keynote Session (12 minutes)
General Keynote Session (50 minutes)
Duration of Proposed Presentation
Primary Speaker Information
Please complete all fields for the primary speaker for this presentation. This speaker will be the point of contact for all conference-related information. If your presentation has 2-4 speakers, please provide all requested information for each speaker (below).
Name
*
First Name
Last Name
Credentials (Maximum 2)
Primary Speaker EAPA Member Number (if applicable)
Leave blank if not a current EAPA Member. Membership not required.
Primary Speaker Job Title
*
Primary Speaker Company
*
Primary Speaker Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code / Country
Primary Speaker Email Address
*
example@example.com
Primary Speaker Phone Number
*
-
Area Code
Phone Number
Primary Speaker Short Bio
*
For publication. 50 Word Maximum.
Primary Speaker Resume/CV Upload
*
Browse Files
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of
Primary Speaker Headshot Upload
Browse Files
Optional at this time. If your presentation is selected, you will need to provide a 600 DPI headshot for conference marketing materials.
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Professional Experience
*
What are your professional experiences and/or academic qualifications related to your training topic?
Relevant Speaking Experience
*
List three (3) relevant speaking experiences(include date, venue, audience size)
References
*
List name, phone number and email address of three references who are knowledgeable of your skills as a presenter.
Conflicts of Interest
*
Describe any commercial support/affiliation you have regarding the content of your presentation.
Speaker #2 Information
Please complete if applicable. If not, proceed to the Presentation Information section.
Name
First Name
Last Name
Credentials (Maximum 2)
Speaker #2 EAPA Member Number (if applicable)
Leave blank if not a current EAPA Member. Membership not required.
Speaker #2 Job Title
Speaker #2 Company
Speaker #2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code / Country
Speaker #2 Email Address
example@example.com
Speaker #2 Phone Number
-
Area Code
Phone Number
Speaker #2 Resume/CV Upload
Browse Files
Cancel
of
Speaker #2 Headshot Upload
Browse Files
Optional at this time. If your presentation is selected, you will need to provide a 600 DPI headshot for conference marketing materials.
Cancel
of
Speaker #3 Information
Please complete if applicable. If not, proceed to the Presentation Information section.
Name
First Name
Last Name
Credentials (Maximum 2)
Speaker #3 EAPA Member Number (if applicable)
Leave blank if not a current EAPA Member. Membership not required.
Speaker #3 Job Title
Speaker #3 Company
Speaker #3 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code / Country
Speaker #3 Email Address
example@example.com
Speaker #3 Phone Number
-
Area Code
Phone Number
Speaker #3 Resume/CV Upload
Browse Files
Cancel
of
Speaker #3 Headshot Upload
Browse Files
Optional at this time. If your presentation is selected, you will need to provide a 600 DPI headshot for conference marketing materials.
Cancel
of
Speaker #4 Information
Please complete if applicable. If not, proceed to the Presentation Information section.
Name
First Name
Last Name
Credentials (Maximum 2)
Speaker #4 EAPA Member Number (if applicable)
Leave blank if not a current EAPA Member. Membership not required.
Speaker #4 Job Title
Speaker #4 Company
Speaker #4 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code / Country
Speaker #4 Email Address
example@example.com
Speaker #4 Phone Number
-
Area Code
Phone Number
Speaker #4 Resume/CV Upload
Browse Files
Cancel
of
Speaker #4 Headshot Upload
Browse Files
Optional at this time. If your presentation is selected, you will need to provide a 600 DPI headshot for conference marketing materials.
Cancel
of
Presentation Information
Please complete all fields for the proposed presentation.
Session Brief Description
*
Please provide a brief overview of your session (intended for publication – 50 words max).
Session Full Description
*
Please provide a detailed description of your proposed session for committee review.
Learning Objectives
*
Provide three (3) behaviorally-based learning objectives (12 words max per).
Citations (Source Materials)
*
List 3, written in APA style.
Past Conferences
*
List any past conferences where this information has been presented. Include date(s) and location(s).
Risk/Benefit Expectation
*
Describe the expected benefits/risks to clients resulting from presented treatment or theoretical approaches.
Accuracy/Utility
*
Describe the accuracy, utility, basis, and limitations, as well as risks associated with the implementation of your content.
Original Research
*
Does this presentation contain original research? If yes, please disclose funding sources.
Attestation
By clicking the Submit button below, I acknowledge all the information provided is accurate and complete to the best of my knowledge. I have read the EAPA 2019 Call for Proposals instructions and, if selected, agree to all speaker requirements.
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