• I understand that reimbursement for honoraria, travel and expenses is not included with the acceptance of presentation and that I am responsible for all travel-related conference expenses and hotel fees.
  • I understand there will be a registration fee if I attend sessions on any day other than the one on which I will be a presenter. Presenters may attend other sessions on the day of their presentation at no charge. CEU credit will only be extended if it is approved for the seminar of your presentation. For CEU credit, you must submit a registration form, indicate SPEAKER on the payment, request the CEU credit, and attend the full day of the seminar for which you are speaking.
  • I will keep the meeting dates of March 6-7, 2017 available until notified of the status of my proposal.
  • I will forward an electronic copy of my handouts to LeadingAge Oklahoma by February 10, 2018. Handouts must be e-mailed in electronic format to include the presentation outline and only content that is directly applicable to the presentation outline.
  • I understand promoting a company, service or product during the presentation is strictly prohibited.
  • I will bring my own laptop and will be responsible for setting up and operating my own equipment.
  • I understand that depending upon the length of the presentation, LeadingAge Oklahoma reserves the right to combine elements of presentations with other related proposals to enhance continuity of programming.
  • I understand that I will receive a confirmation letter by December 15 with the seminar agenda and speaker details.
  • I will inform my co-presenter(s) of these policies.

☐I agree to the above terms.

Membership Level:

☐LeadingAge Oklahoma Member

☐LeadingAge Oklahoma Business Associate Member

☐LeadingAge Oklahoma Subscriber

☐Non-Member

Presentation Format

☐I would like to present a break-out session

☐I would like to present a keynote address

☐I would like to facilitate a panel discussion

Presenter Information:

Name: / Click here to enter text. / Title: / Click here to enter text.
Organization: / Click here to enter text.
Address: / Click here to enter text. / City, State, Zip: / Click here to enter text.
Phone: / Click here to enter text. / Cell
Phone: / Click here to enter text. / E-mail: / Click here to enter text.
Credentials: / Click here to enter text.

Co-Presenter Information:

Name: / Click here to enter text. / Title: / Click here to enter text.
Organization: / Click here to enter text.
Address: / Click here to enter text. / City, State, Zip: / Click here to enter text.
Phone: / Click here to enter text. / Cell
Phone: / Click here to enter text. / E-mail: / Click here to enter text.
Credentials: / Click here to enter text.

Contact Person if presentation selected:*

Name: / Click here to enter text. / Title: / Click here to enter text.
Phone: / Click here to enter text. / Cell
Phone: / Click here to enter text. / E-mail: / Click here to enter text.

List other conferences where you have presented:

Click here to enter text.

Required:

Please attach biographical information to include your current position, experience, and education. This information is required by credentialing agencies to approve CEU credit for seminars and may also be used for your introduction.

Topic/Section: / Click here to enter text. /
Target Audience: / Click here to enter text. /
Presentation Title:
(Subject to approval): / Click here to enter text. /

Learning Objectives (List the learning objectives for participants, specifying what they will be able to do as a result of presentation (i.e. learn, understand, discuss, examine, identify, explore, analyze, etc.) LeadingAge Oklahoma reserves the right to edit learning objectives for brochure production and CEU approval.

1) / Click here to enter text.
2) / Click here to enter text. /
3) / Click here to enter text. /
4) / Click here to enter text. /

Presentation Format:

Select the presentation formats/approaches you will utilize during your presentation (please check all that apply). Interactive presentations are encouraged along with providers as co-presenters.

☐Group Exercises

☐Interactive Panel Discussions

☐Facilitated Brainstorming

☐Learning Circles

☐Group Discussions

☐Lecture

Session Summary (50 words or less):
Click here to enter text. /

Questions? Please contact Lisa Hill at or (405) 501-1170.