Professional Development Program Speaker Intake Form

Session Information

Type of Program*

Are you presenting at our lunch program or via webinar?

Program Date*

Pick the date of your program.

Program Title*

What is the title of your program?

Program Description*

Describe your program. This text will appear in the Event description and also in our Newsletter. So be creative and use spell check.

Program Learning Objectives

In this program, you will learn...

Select the OPM ECQs your session covers.*

Please choose at least one.

Presenter Name*

First Last

Presenter Email

Presenter Phone

Presenter Website

Note that we will include all of the above contact information in the Event details, if you provide it.

Presenter Bio*

Please tell us about yourself. This text will appear in the Event description and also in our Newsletter.

Presenter Photo (OLD)

Please upload a professional photo of yourself. Preferred 300x300 pixels, no larger than 2MB.

Presenter Photo

Please upload a professional photo of yourself. Preferred 300x300 pixels, no larger than 2MB.

Online Presentation Experience

Please tell us about your experience presenting online so we know how best to help you.

Phone

This field is for validation purposes and should be left unchanged.