Apraxia Kids National Conference Speaker Application 1

First Name of Presenter *

Last Name of Presenter *

Organization for which you work *

Credentials *

Degree, University(s) attended, Year(s) completed *

Email *

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Please provide a brief bio (250 words or less) for posting in the Conference Program online. *

Conflict(s) of Interest: (financial and non-financial) * Conflict(s) of Interest: (financial and non-financial)

Will this be your first time presenting at the Apraxia Kids National Conference? *

Yes

No

In total, how many different speaker presentations are you on as a principle or co-presenter?

Will you have any co-presenters?

Yes

No

Please enter first and last names and emails of all co presenters. Place an asterisk (*) next to the Principle Presenter if it is not yourself.

Please list up to 4 educational conferences you have presented at within the last 3 years. If you have not presented in the last 3 years, type "None". *

By submitting this application, I explicitly attest that I have read and agree to the PRESENTATION GUIDELINES found on the Speaker Application Information page (see link below signature box). Additionally, I acknowledge that the conference is being planned as a virtual event with sessions having the ability of being recorded simultaneously as they are being presented live on the virtual platform and will be available as a virtual option throughout the conference period with speaker permission. Please indicate your agreement by clicking in the box below and typing your full name. *

Clear

Presentation Guidelines can be found on the National Conference Speaker Information page.

Part 1: Speaker’s Information

About Apraxia

Useful Information

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