Call for Proposals

2016 NAPT Conference Proposal Form

Name and title(s) of first presenter (this name will be used as contact person for the group): / Name(s) and titles of co-presenter(s)
IFBPT Crentential: ____ CPT ____PTR ____CAPF
(Presenter does not need to be IFBPT certified to be considered)
Email address of contact person for group:
(Email
if the email address changes) / Mailing address of contact person for group:
Phone numbers with area codes of contact person
Cell
Work / Title of proposed workshop:
Length of workshop:
____90 minutes (Workshop Fri or Sat)
____ 2 ½ hours (Pre or Post Conf. Thurs)
_____ Other (please explain) / Category of proposed workshop:
% Experiential ____ % Didactic___ = 100 %
____Conference workshop for Friday/Saturday (90 min)
____Pre-conference workshop for Wednesday or
Thursday (only former presenters may
propose for this category except by invitation)
____Post-conference workshop for
Sunday (only former presenters may propose for this
category except by invitation)
_____ Other (Please describe in detail by filling out this form and attaching any additional information):
Set-up style:
______chairs in a circle
______theater style
______tables and chairs in a square
______other (please explain):
A/V needs (please keep to a minimum; A/V equipment is expensive and should be requested with discretion): / Max. number of participants: ______
(no more than 30)
50-word abstract/description of workshop for conference program: / Checklist:
___Completed proposal form including 50-word abstract
Attachments:
___250-word description of proposed workshop ( including your goals for the participants of the workshop)
___Current CV for each presenter
___Proof of IFBPT certification if applicable
___ Signature
___50-word biographical statement for each presenter
Biographical Statement for each presenter for listing in the program (no more than 50 words)
Comments (please include any constraints on presenters’ availability for Friday/Saturday and/or special needs or requests):

“I have neither been sanctioned nor had any adverse actions against me in the past five years.”

Signed (file) ______

CV or Resume:Attached