Please return both pages of this form to Meg Steimle at no later than September 30, 2018. Presenter Information Primary Presenter Name: Primary Presenter Title and Company/Organization Name: Co-Presenter Name: Co-Presenter Title and Company/Organization Name: Presentation Information Presentation Title: Provide a 2-3 sentence description of the presentation (this may be edited and used for the conference brochure): (There is a 400 character limit on this field) List three learning objectives/outcomes: 1. 2. 3. Indicate topic area below (refer to Information and Instructions sheet for additional description): Adult services and support, including transition to life after high school Body, Mind, and Spirit Community Education, including early intervention and early education Family, Self-Care, Health, and Wellness Health care Long-Term Care Leadership and Advocacy Other: Indicate content level: Beginner Intermediate Advanced General Additional Information Has this information been presented at conferences previously: Yes No If yes, list conference, including previous Circles of Life conferences: Are you willing to repeat the presentation: Yes No
Presenter Information Primary Presenter Name: Primary Presenter Title and Company/Organization Name: Co-Presenter Name: Co-Presenter Title and Company/Organization Name: Presentation Information Presentation Title: Provide a 2-3 sentence description of the presentation (this may be edited and used for the conference brochure): (There is a 400 character limit on this field) List three learning objectives/outcomes: 1. 2. 3. Indicate topic area below (refer to Information and Instructions sheet for additional description): Adult services and support, including transition to life after high school Body, Mind, and Spirit Community Education, including early intervention and early education Family, Self-Care, Health, and Wellness Health care Long-Term Care Leadership and Advocacy Other: Indicate content level: Beginner Intermediate Advanced General Additional Information Has this information been presented at conferences previously: Yes No If yes, list conference, including previous Circles of Life conferences: Are you willing to repeat the presentation: Yes No Please return both pages of this form to Meg Steimle at no later than September 30, 2018.
2019-CoL-Presentation-Application-CYSHCN-FINAL1.docx