CEU Seminar Presenter

PRESENT YOUR TOPIC WITH THE AMERICAN NAPRAPATHIC ASSOCIATION

ANA CEU Presenter Information & Application

CEU Presenter / Speaker Information Intake Form

We appreciate your interest and involvement in our upcoming event. Our organization compensates our presenters at an hourly rate of $100. Please complete our intake form to help us get better acquainted with you and the topic you are presenting. Contracts are not approved until materials are reviewed by Continuing Education Committee.

Presenter / Speaker Name *

First

Last

Please provide all applicable credentials and titles you hold

Presenter / Speaker Credentials *

***May write N/A, if not applicable to you.***

Email *

Phone *

Please Tell Us the Name of Event and Date of Event You are Invited to *

Feel free to ask the member or affiliate who invited you

Title or topic of talk *

Please Provide Course Abstract in space provided *

Feel free to upload your course abstract if available and type “Upload” in the space here.

Participant Supplemental Materials, Props, Tools, Equipment etc… *

Feel free to list any materials (if applicable) that you would prefer participants bring or have handy for your presentation in the space here.

Course Abstract File Upload (Optional)

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload pdf or word formats

A Brief Bio in space provided *

Feel free to upload your bio if available and type “upload” in space here.

Upload Bio & Headshot *

Click or drag files to this area to upload. You can upload up to 3 files.

Please provide a professional headshot to be displayed for the event. Headshot/Bio combinations are accepted.

AGREEMENT AND SIGNATURES

The undersigned hereby certifies that the foregoing statements are true and correct and included all of the material necessary to identify and explain the operation of the lessons described herein. The undersigned agrees to provide the ANA with current, complete and accurate information for each project contracted and for all proposed changes in any contractual agreement. Misrepresentations shall be grounds for terminating any contract. *

I agree

I understand the presenter application form is subject to approval of all materials presented herein and completion of this form does not guarantee approval and is not a binding contract between myself and the American Naprapathic Association. *

I understand and agree

Presenter / Speaker Signature *

Date *

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