Webinar Proposal Information Form
We are seeking presentation proposals. If you are interested, please complete the following information formand submit to . Please be sure to attach your CV or Resume, and include the information detailed below. Proposals will be reviewed by the Webinar Proposal review committee and you will be notified of acceptance by email.
General Webinar information
Webinars are typically scheduled with one speaker for one hour; with 50 minutes for the presentation and 10 minutes for questions. The practice group’s Webinar Coordinator will work with the presenter to schedule the presentation date and time. We typically try to schedule webinars during the middle of the day for best attendance.
Speakers receive a total of a $250 stipend for the webinar (if there are two speakers they will receive $125 each). Please note that all accepted speakers are sent a speaker agreement to review/sign. Completed agreements are submitted to the Webinar Coordinator prior to the presentation. If you have any questions, please contact us at .
Speaker Information:
Speaker Name/ Credentials:
Employer/ Affiliation:
Membership Status:□ BHN MemberAcademy Member # ______
□ Non Member
Practice Area:
Addictions Eating Disorders
Mental HealthIntellectual and Development Disabilities
Has this presentation been given before?YESNOHow many times? ______
Where and when was/is the presentation scheduled?
Session Information:
Session Title:
CPE Level:
Level 1: Little or no prior knowledge of subject.
Level 2: General knowledge of literature and professional practice in areas covered.
Level 3: Thorough knowledge of literature and professional practice in areas covered.
CDR CPE LEARNING NEED CODE(S): (minimum of 4)
Please use attached LNC for numbers
PERFORMANCE INDICATORS: (minimum of 3)
Please view attached link:
Objectives (maximum 3):Please complete the following statement, “After this presentation, the attendees will be able to:”
1.
2.
3.
Session Description: Provide a 2-3 sentence focused statement explaining the session content and rationale for the presentation. This statement may be used in promotional materials that describe the session and should reflect the previously stated objectives.
Session Outline: Provide adetailed outline describing the topic as it relates to the session objectives, including teaching methods. It is important that the information presented is evidenced based and includes practical strategies for application to the practice of dietetics in behavioral health. Case studies are helpful to include in the presentation.
Session Questions: Provide 8 questions, with the answers participants should be able to answer after completing the webinar.
Speaker Biographical & Contact information:
This information must be completed to assist in the webinar introduction as well as promotion of the webinar. Please attach a curriculum vitae or resume limited to 2-pages.
Full Name: (first name, middle initial, last name)
Credentials/ Degrees:
Position Title:
Place of Employment:
Business Address:Home Address:
City:City:
Business Phone:Home Phone:
Fax Number:email:
Email:
Social Media Addresses:
Facebook:
Twitter:
Can we tag you in promotional events?
What is your preferred address for correspondence? HomeBusiness
Recent Career Highlights:
Qualifying experience enabling you to speak on your topic: (one or two sentences)
In your own words, please write a brief introduction for yourself: highlight career and professional information or events (maximum 250 words)
@BHNDPG facebook.com/BHNDPG@bhn_dpg
BHNDPG.org
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Revised 7/25/18