ADRP Conference Speaker Application Form
Submission deadline: December 31, 2019.
Primary Speaker's Name
*
First Name
Last Name
Display Name
*
How name should be name listed in the program (including prefix and/or suffix)
Title
*
Professional job title
Bio
*
Up to 100 words
Email
*
Confirmation Email
Email 2
(Only if you would like to receive notifications to both emails)
Phone Work
-
Area Code
Phone Number
Phone Mobile
-
Area Code
Phone Number
Facebook URL
Linkedin URL
Let attendees connect with you by providing social media links
Upload Headshot Photo
Browse Files
Cancel
of
Co-Presenter's Name if applicable
First Name
Last Name
Display Name
How name should be listed in the program (including prefix and/or suffix)
Title
Professional job title
Bio
Up to 100 words
Email
example@example.com
Upload Headshot Photo
Browse Files
Cancel
of
Co-Presenter's Name if applicable
First Name
Last Name
Display Name
How name should be listed in the program (including prefix and/or suffix)
Title
Professional Job title
Bio
Up to 100 words
Email
example@example.com
Upload Headshot Photo
Browse Files
Cancel
of
Organization Name
*
Website
company website
Website 2
Alternate website. For example, a parent company
Address
Address 2
City
*
State
State or Province
Country
*
Presentation Category
*
Recruitment/Account Management
Collections/Donor Services
Calendar Management/Staffing
Marketing/Communications
Operations (General)
Leadership
Medical
Select all that apply
Title of Your Session
*
Abstract: The abstract should be one paragraph up to 250 words.
*
Learning objectives
*
Required for sessions that allow P.A.C.E. continuing education credits to attendees
Intended Audience
*
Front Line/Donor-facing Staff
Supervisor/Manager
Director/Senior Leader
Executive
Will you require video capability?
Yes
No
Does your presentation include any audience interactive activities? If so, please provide details
Have you given this presentation before?
*
Yes
No
If yes, please list where and when - If no place N/A in the box.
*
I understand that my presentation will be available on the ADRP website for members to download
*
Yes
No
Submit Your Speaker Application
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