Apraxia Kids National Conference Speaker Application 1 - Apraxia Kids

Part 1: Speaker’s Information

All speakers must fill out this Part one application ONE time.

National Conference Speaker Application Part 1

First Name of Presenter *

Last Name of Presenter *

Organization for which you work *

Credentials *

Degree, University(s) attended, Year(s) completed *

Email *

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Country

Country

Phone *

Please provide a brief bio (250 words or less) for posting in the Conference Program online. *

Optional: Please upload a professional photo of yourself to use in conference promotional materials.

Maximum file size: 516MB

Conflict(s) of Interest: (financial and non-financial) *

Please tell us about your real or perceived conflicts of interest that relate to this presentation:

Will this be your first time presenting at the Apraxia Kids National Conference? *

Yes

No

In total, how many different speaker presentations are you on as a principle or co-presenter?

Please list up to 4 educational conferences you have presented at within the last 3 years. If you have not presented in the last 3 years, type "None". *

Please indicate your agreement by signing below or click the keyboard and type your full name in the box below. *

Presentation Guidelines can be found on the National Conference Speaker Information page.

If you are human, leave this field blank.

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