Ohio State 10th Annual ID/MH Conference- Mental Health Aspects -Treatment & Support

September 18th & 19th, 2012
Doubletree Hotel, Columbus/Worthington, OH 

 

Speakers to provide the following information for each presentation:

Please provide necessary documents in MS Word, 

  • Here On-Line

  • By Mail (2) Hardcopies of the proposal with MS Word document files on a CD, containing this printed form, required information from *(III and III a. (CV or resume for each presenter).

    Mail to: NADD 132 FAIR ST. KINGSTON, NY 12401

DEADLINES

  • The Submission Form and supporting documents must be received in the NADD office by mail or on-Line by March 16, 2012. Submissions received after this date will not be considered. 

    Notification of Acceptance will be e-mailed by April 20, 2012

Please scroll through the form below and compile the information necessary before you begin.
You will not have the ability to start and stop to complete at a later date.

Ohio State 9h Annual MI/DD Conference Presentation Submission Form

Ia. Type of Presentation:

Presentation (90 mins.)
Skill Building Workshop (3 hrs.)

Ib. Presentation Title (No more than 6 words maximum)

Ic. Topic Description (Please check the one (1) description that best applies to your proposal.)

Aging
Counseling & Therapy
Diagnosis & Assessment
Drug Therapy
Environmental Health
Family Issues
Offenders

Program Models
Research
Residential Services
Social & Sexual Issues
Staff Training
Substance Abuse
Syndromes
Other

II. Contact Information / Speaker Fees

PRIMARY PRESENTERS including Registration Fees-

The primary presenter will receive all NADD correspondence and will be responsible for communicating all information including Audio Visual coordination to other presenters on the team.

  1. 90 (min.) Presentations & 3 (Hr.) Workshops given by Primary Presenters receive a complimentary daily conference registration fee.  Clients with Primary presenters used in case examples are not required to pay a registration fee, please account for below.

  2. Please Note: Secondary presenters for the various presentation types will be responsible for full registration fees.

Primary Presenter

First Name

Last Name

Credentials

Professional Title

Program

Agency

Street

City

State / Province, Zip Code

,

Country

Phone

Fax

E-mail Address

III. All Presentations require: In one (1) MS document file, separated by page breaks.  (Required for Continuing Education application, etc.)  

  • Compile a description of the presentation in 50-words with;

  • A copy of the presentation/workshop handout or an outline of at least one page in length - whichever is submitted, it will need to include 1-3 annotated references;

  • Please list below two (2) - three (3) educational objectives for your presentation (I.e.- Participants will identify..., Participants will be able to develop...)

Click Browse to locate the file on your computer

IIIa. All Presentations require:

Complete copy of the primary presenters curriculum vitae or resumé. This should be in MS Word or PDF format. Click Browse to locate the file on your computer

IV. Audio Visual Requirements (please check all that apply). NADD will provide the following:

Podium Microphone
Flip Chart/Markers
LCD Projectors only, presenters are required to bring their own Laptop Computers
Screen
My presentation requires Audio Feed/Sound for Video Clips

PLEASE NOTE: It is the responsibility of the presenter to make arrangements for, and cover the rental fee of AV equipment not listed above.  Primary presenters are also responsible for Audio Visual coordination to other presenters on the team.

V. This is of Total presentations submitted by the primary presenter.

I have client(s) which will accompany me at the presentation.

VI. Secondary Presenters

Please include a one- (1) page curriculum vitae or resumé of each individual listed; if none, leave blank. All secondary presenters for the various presentation types are responsible for payment of all registration fees. Note: There is a limit of four (4) secondary presenters for all presentations.

Secondary Presenter #1 of 4 (leave blank if none)

First Name

Last Name

Credentials

Professional Title

Program

Agency

Street

City

State / Province, Zip Code

,

Country

Phone

Fax

E-mail Address

One - (1) page curriculum vitae or resumé

This should be in MS Word or PDF format. Click Browse to locate the file on your computer

Secondary Presenter #2 of 4 (leave blank if none)

First Name

Last Name

Credentials

Professional Title

Program

Agency

Street

City

State / Province, Zip Code

,

Country

Phone

Fax

E-mail Address

One - (1) page curriculum vitae or resumé

This should be in MS Word or PDF format. Click Browse to locate the file on your computer

Secondary Presenter #3 of 4 (leave blank if none)

First Name

Last Name

Credentials

Professional Title

Program

Agency

Street

City

State / Province, Zip Code

,

Country

Phone

Fax

E-mail Address

One - (1) page curriculum vitae or resumé

This should be in MS Word or PDF format. Click Browse to locate the file on your computer

Secondary Presenter #4 of 4 (leave blank if none)

First Name

Last Name

Credentials

Professional Title

Program

Agency

Street

City

State / Province, Zip Code

,

Country

Phone

Fax

E-mail Address

One - (1) page curriculum vitae or resumé

This should be in MS Word or PDF format. Click Browse to locate the file on your computer

Incomplete proposals will not be reviewed for acceptance.

SUBMISSION MATERIALS DUE DATE IS March 16, 2012

Notification of Acceptance e-mailed April 20, 2012

Questions, comments and concerns regarding your submission contact lchristie@thenadd.org

 

 

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