Call For Presentation

Call For Presentation

Primary Speaker Information

Form Date Field*

First Name*

Last Name*

Credentials

Company Name*

Company Position/Title*

Company Address*

City*

State*

Zip Code*

Phone*

Email*

Indicate the associations, if any, of which you are a current member (mark all that apply)

Select or enter value

Please describe any honorarium/travel expense requests*

(or indicate N/A)

Co-presenters

Will you have co-presenters?*

Select or enter value

Co-presenter 1 (Name, Phone, and Email)

Co-presenter 2 (Name, Phone, and Email)

Co-presenter 3 (Name, Phone, and Email)

References

If first time presenting for Nebraska Health Care Association.

Reference 1 (Name, Company and Email)

Reference 2 (Name, Company and Email)

Reference 3 (Name, Company and Email)

Presentation Information

Title of Presentation*

Session Description (100 words or less)*

Learning Objectives*

Please list at least 3 Please click here for a list of recommended verbs - https://www.nehca.org/wp-content/uploads/Verbs-for-Objectives.pdf At the end of this session, attendees will be able to:

Presentation Length*

Ex. 30 minutes, 60 minutes, 2 hours Note: Average length of session is 60-75 minutes

Audience*

Please select from the dropdown options below. If not listed, please type your audience and enter in the box below

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Upload Speaker Bio and Headshot (Optional)

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