EmailMeForm
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
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
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?
None
1
2
3
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
*
By signing and clicking submit, you are acknowledging the Procedures outlined above.
Date Time
*
MM
/
DD
/
YYYY
Image Verification
Please enter the text from the image:
[
Refresh Image
] [
What's This?
]