WHCA/WiCAL Presenter Application Form - WHCA/WiCAL

WHCA/WiCAL solicits educational program proposals on a rolling basis and is always accepting applications for presentations, including webinars, in-person workshops, and Spring Conference and Fall Convention programming! Please fill out the form below. If you have additional questions, please direct them to Jena Jackson, Vice President of Business Development, at jena@whcawical.org

Requests for Presentation will be reviewed for inclusion at our Conferences and Conventions and other educational programs offered throughout the year. All presentations will be kept on file.

Presenter Application Form

Seminar Title:*
Seminar Length:*
60, 75, or 90 Minutes
Target Audience:*
Please indicated Skilled or Assisted Living or Both, and if necessary, the applicable sub-set (can also be "ALL"): Administrator/ED, Clinical, Ops, Support Staff, Direct Care Giver, etc.
Presenter Information
Speaker Name*
First Last
Company/Organization:*
Primary Address:*
Street Address Address Line 2 City State ZIP Code
Phone:*
Email:*
Education information (required for NAB Approval) — degree(s) obtained and year(s) of graduation:*
Honorarium (if required)
Understand, WHCA/WiCAL is a non-profit state trade association. Participation in our events provides speakers with impactful engagement with members and event attendees. WHCA/WiCAL provides 1 night accommodations to all speakers & meals/refreshments are provided at the event.
Seminar Objectives:*
Session Description:*
Please provide a summary of the seminar’s content. The summary must include a concise description of content which explains the value of the information and identifies new or unique applications, and a description of the learning techniques that will be used to encourage discussion, participation and learning.
Speaker Bio:*
A one-paragraph bio indicating speaker’s applicable skills & background should be submitted with your RFP. This will be used in introductions at the sessions as well as in the brochure.
Headshot:
Formats: jpg, jpeg, png | Max File Size: 10MB
Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.
References*
At least one presentation reference is required. This can be a source, book, article, education, etc.; required by WHCA/WiCAL for continuing education credit approval
Additional Speaker?*
- Yes
- No
Additional Speaker Name*
First Last
Additional Speaker Company/Organization:*
Additional Speaker Primary Address:
Street Address Address Line 2 City State ZIP Code
Additional Speaker Phone:*
Additional Speaker Email:*
Additional Speaker Education information (required for NAB Approval) — degree(s) obtained and year(s) of graduation:*
Additional Speaker Bio:*
A one-paragraph bio indicating speaker’s applicable skills & background should be submitted with your RFP. This will be used in introductions at the sessions as well as in the brochure.
Additional Speaker Headshot:
Formats: jpg, jpeg, png | Max File Size: 10MB
Accepted file types: jpg, jpeg, png, Max. file size: 10 MB.
Comments
This field is for validation purposes and should be left unchanged.

Presenter Application Form

Presenter Information