Submission Information

1. Please answer the questions below: *This question is required.

First Name

Last Name

Credentials (ex: MA, PhD, CEDS, M.D., etc)

Company/Employer

Street Address

Apt/Suite/Office

City

State

Zip

Email Address

Brief Bio *This question is required.

2. Photo Upload *This question is required.

File: {{filename}} delete

3. CV Upload *This question is required.

File: {{filename}} delete

4. Provide a list of examples of your recent presentations. Include up to 10 recent presentation titles, dates and locations. *This question is required.

5. Do you have a secondary presenter? *This question is required.

6. If yes to #5, please list the name(s) and credentials of any additional presenters.

7. Presentation Title *This question is required.

8. 150 Word Abstract *This question is required.

9. Brief Presentation Outline and 90 Minute Agenda *This question is required.

10. Three Learning Objectives (Complete the sentence: Following this presentation, attendees will be able to...) *This question is required.

11. Three Literature References (Dated within last 10 years) *This question is required.

12. Three True/False Competency Questions (Attendees should be able to answer said questions at the conclusion of the presentation. Please include correct answer.) *This question is required.

All submissions will be acknowledged by email and selected presenters will be notified of additional deadlines. For questions, please contact Heidi Farmer, Professional and Consumer Resources Coordinator, at hfarmer@eatingrecoverycenter.com.