Presentation Request Form

Proposed Presentation Date

Name *

Title *

Company *

Phone *

Email *

Session Information *

This information will be used to market the program and to certify that it is eligible for HRCI re-certification credits. Please Note: NCHRA may change and/or reduce your title/description for program clarity in promotional communication. TITLE OF SESSION: LENGTH OF SESSION: SYNOPSIS OF PRESENTATION: In 150 words or less, provide a summary of the content:

Learning Objectives *

Describe the top three learning objectives of your presentation:

Audience Experience *

Introductory - requires little or no previous knowledge of the subject matter

Intermediate - requires at least a basic knowledge and some experience

Advanced - requires a working knowledge and considerable experience

Check the box that best describes the level of knowledge participants should have to benefit from your presentation.

Presenter Information *

Please provide a biography (100 words or less) which illustrates how you are qualified to present this topic. Information should include professional experience, education, presentations made (including program sponsor, topic presented, and date presented), and articles and books published.

Speaker Information *

I DO NOT require a speaker fee or travel expenses

I DO require a speaker fee or travel expenses

My program HAS been certified for credit

My program HAS NOT been certified for credit

Additional/Co-Presenter

Please let us know if you will be having a Co-Presenter, and if so, please list their Name, Title and Company:

References *

Please provide the name, organization and phone number of 2 references who can attest to the quality of your previous presentations:

Audio/Visual Equipment Needs

Special Requirements or Instructions

Please list any special instructions for the request. Please note here if you are sending a separate email with additional instructions or attachments.

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Northern Colorado Human Resources Association