CALL FOR PROPOSALS
2018 CLINICAL NUTRITION MANAGEMENT DPG SYMPOSIUM
Moving Your Nutrition Vison to a Plan of Action!
Shaping the next Century of Nutrition and Dietetics Practice
Embassy Suites, Albuquerque, NM
March 15th-17th 2018 (New! Thursday though Saturday)
Symposium Session Information Form
Session Title:
PREFERRED SESSION DAY: Please check the day you prefer your proposed session to be scheduled based on availability. The CNM Professional Development Team will attempt to accommodate scheduling requests, but reserves the right to assign sessions based on programming needs.
Friday Saturday
Learning Objectives: (maximum 3): This information should complete the following statement, “After this presentation, the attendees will be able to:”
1.
2.
3.
Session Outline:Please briefly describe each speaker's topic as it relates to the symposium's overall objectives and Learning Codes/Competency Codes.
EQUIPMENT NEEDED FOR PRESENTATION
Presentation Format:
Interactive Instruction
Workshop
Skill set development – Core Concepts with Participant Interaction Activity
Storytelling, Action Learning
Lecture
DESCRIPTION (Focus Statement) Write a brief summary of the presentation and relevance of topicto Clinical Nutrition Managers and other attendees. This statement may be used as supportive promotional materials for the session and should be reflective of the previously stated objectives.
CNM SYMPOSIUM speaker reimbursement policy
- Professionals selected to speak will receive complimentary registration to the annual symposium and reimbursement against travel expenses of up to $1000.
- No more than 1 speaker per session will be eligible for the speaker reimbursement against travel.
- Other reimbursement requests may be considered on a case by case basis.
Return form by October 9th, 2018 to: Kathy Allen, Professional Development Committee Chair at and Barb Pyper at
1st Speaker Biographical Sketch & Release of Contact Information
This information must be completed to assist your presiding officer in writing your introduction and to verify that our information is accurate for publication. You mayinclude curriculum vitae.
First Name Initial Last Name
Credentials/Degrees
Presenter at CNM Symposium 2017 ___ yes no Presenter at CNM Symposium 2016yes no
Position Title
Place of Employment
Contact Information:
Street ______City ______State ______Zip ______
Phone number ______Cell Phone number______
email address: ______
Brief Bio for Introduction
______
Previous speaking experience (please provide titles, audience size, and audience composition):
______
Qualifying experience enabling you to speak on your topic (one sentence or short example):
______
Reimbursement Request:
Complimentary registration and up to $1000 expense reimbursement provided). If more than 1 speaker submitting to speak, please indicate which one will receive reimbursement against travel.
Academy member? Yes No Registration number? ______
CNM Member? Yes No
Other Reimbursement Requests
Would you be willing to write an article for the CNM DPG Newsletter based on your proposal? Yes No
2nd Speaker Biographical Sketch & Release of Contact Information
This information must be completed to assist your presiding officer in writing your introduction and to verify that our information is accurate for publication. You mayinclude curriculum vitae.
First Name Initial Last Name
Credentials/Degrees
Presenter at CNM Symposium 2017 ___ yes no Presenter at CNM Symposium 2016yes no
Position Title
Place of Employment
Contact Information:
Street ______City ______State ______Zip ______
Cell Phone number ______Alternate Phone Number: ______
E-mail address: ______
Brief Bio for introduction:
______
Previous speaking experience (please provide titles, audience size, audience composition):
______
Qualifying experience enabling you to speak on your topic (one sentence or short example):
______
Reimbursement Request:
Complimentary registration and up to $1000 expense reimbursement provided). If more than 1 speaker submitting to speak, please indicate which one will receive reimbursement against travel.
Academy member? Yes No Registration number? ______
CNM Member? Yes No
Other Reimbursement Requests
Would you be willing to write an article for the CNM DPG Newsletter based on your proposal? Yes No