Call for Speakers
Share your expertise with us! Serve as conference speaker, session facilitator, presenter, or be part of a panel discussion. PHA opportunities include Annual Conference, Regional Meetings, Direct Care Worker Forum, and many educational webinars. To be considered for upcoming speaking opportunities, please fill out the form below.
Name (Primary Presenter)
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
LinkedIn
Co-Presenter (if applicable)
First Name
Last Name
Email
example@example.com
Presentation Information
Presentation Title
*
Presentation Summary (short summary below or upload a document below)
Presentation Summary Upload
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of
Length of Presentation
*
Please Select
30 minutes
45 minutes
50 minutes to 1 Hour
2 Hours
3 Hours
4 Hours
Other
"Other" Length of Presentation
Learning Objective 1
*
Learning Objective 2
*
Learning Objective 3
*
PHA Events of Interest
Select All of Interest
Compensation
*
Annual Conference (in-person)
Regional Meetings (in-person)
Direct Care Worker Forum (in-person)
EVV Check-In (in-person)
Lunch and Learn Webinar
Educational Webinar Standalone
Educational Webinar Series
Other
Presentation Cost(s) to PHA
Compensation
*
No Cost to PHA
Honorarium
Speaker Fee
Airfare
Mileage
Automobile rental
Conference Registration
Per diem
Hotel Accommodations
Other
Honorarium Amount
Speaker Fee Amount
Per Diem Days
Number of days (including travel days)
Nights of Hotel
Speaker Bio or Resume
Attachment: Bio or Resume
*
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of
Portfolio
Body of Work
Previous Speaking Engagements (list organization, year of presentation and presentation topic)
Link(s) to Resources of Past Presentations (videos or Slideshare)
Optional -- Attachment: Presentation Examples (PowerPoint, Whitepapers, or Handouts)
Browse Files
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of
Acknowledgements
I affirm that I own or otherwise have the right to use the proposed content. I further affirm that I have the right to give consent to publish the content. By submitting this form, I grant PHA permission to share my presentation with its members and reporting agency.
I understand that I will be photographed and videoed during my presentation and that my photo and video may be used for educational and promotional purposes by PHA.
Signature
*
Submit
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