Speaker Application | MACA

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Spring 2022 Conference Registration Form

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MACA CONFERENCE
PRESENTER APPLICATION

First Name

Last Name

Credentials

Email

Phone

Street Address

City

Region/State/Province

Postal / Zip code

Biography

County (Franklin, Osage, Laclede, etc.)

Presentation Topic

Title of Presentation

Synopsis of Presentation

Audio/Visual Needs

Flip Chart

PowerPoint Projector

Copies

Nothing Required

Presentaton Day Preference

Friday (Morning)

Friday (Afternoon)

Saturday (Morning)

Saturday (Afternoon)

No Preference

Length of Presentation

2 Hours

3 Hours

More than 4 Hours

Speaker Reimbursement Option. (Select ONE)

Free CEU's

$50 per hour reimbursement of presentation

Donate my time to speak

I would like to be considered for a back-up Presenter

YES

NO

Upload photo

Upload File

Upload supported file (Max 15MB)

Example of photo...

example of photos.jpg

I will be attending to obtain CEU's

NOTE: Speakers will be notified if chosen to present.

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