EmailMe Form - Call for Presentations

Call for Presentations

2013 NCHN Annual Conference
“All that Jazz!”

New Orleans, LA: Omni Royal Orleans Hotel
April 16 - 19, 2013

Deadline for Submissions: Wednesday, October 17, 2012

The National Cooperative of Health Networks Association (NCHN) invites NCHN members, Business Partners and guests with an interest in health networks to submit proposals for presentations at our 19th Annual Conference in New Orleans. “All that Jazz!” will be an opportunity for network leaders to gather and share with their peers.

NOTE: If you have to make corrections to your form because you have not completed all required fields, remember to also re-enter the CAPTCHA (at the bottom of the form) before clicking Submit.

About the Presenter(s)
Please complete the information for the presenter. Please make sure that the email and the phone number are that of the presenter, as it will be used for future correspondence regarding the Conference.
First Name *
Last Name *
Title *
Organization *
Email Address *
Phone Number *
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
A recent picture of the presenter (this will be used on the website and conference program)
A brief bio (1-2 paragraphs) for the presenter (this will be used in the conference program and website) *
Additional Presenters
If you will have more than one presenter, please attach a file with the following information:

Additional Presenter's Name, Email Address, Phone Number, Title, Organization

A short bio and photo
How many additional presenters will be speaking during this session?
Presenter 2: Name, Title, Organization, and Email Address
Presenter 3: Name, Title, Organization, and Email Address
Presenter 4: Name, Title, Organization, and Email Address
Please upload a file that includes a photo and short bio for all additional presenters
About the Presentation
Please complete all fields related to your presentation.
Title of Presentation *
Type of Presentation *
Plenary
Concurrent
Mini-Workshop
Target Audience *
Horizontal Networks
Integrated Vertical Networks
Overall Generall Management (for all Networks)
Two sentence description for the Conference program *
One or two paragraphs describing the presentation, including learning objectives of the presentation – what the attendees will take away (This information will be utilized to promote the conference and your presentation.) *
Procedures
Presenters are responsible for all expenses related to delivering the presentation, if selected to present, including travel, lodging and meals, and the conference registration fee; however, non-NCHN member presenters may register for the conference at the membership rate.

The 2013 Annual Conference Planning Committee reserves the right to make final decisions on the selection of all presentations. Presentation applicants who have been selected to present will be notified by December 15, 2012 so that travel arrangements can be made.

The 2013 Conference Planning Committee looks forward to receiving your proposal.

If you have questions, contact Rebecca Davis at rdavis@nchn.org or 970-712-0732.
Signature *
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Date Time *
MM / DD / YYYY
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About the Presenter(s)

Additional Presenters

About the Presentation

Procedures