Workshop Proposal Form 2018

Address

Presenter Bio *

If this is included in your attachment, please type "See Attachment" 0/500
Will you be travelling from outside of Southern California? If Yes, Where from? *
CIty and State
Degree (if applicable- i.e. BA, BS, Ph.D, MSW, etc.) *
Presenter Resume *
This will be used for our CEU (Continuing Education Units) form
Presenter Headshot/Photo *
This will be used for our website and promotional materials
Agency, Company, Organization or School *
Additional Facilitators *

Yes No
If YES, please list the First and Last names (and Email Addresses) of Additional Facilitators
Will a Panel be included? *

Yes No
If YES, please list the First and Last names (and Email Addresses) of Panelists