In Person Conference Presenter Application

Basic Presenter Information

First Name
Last Name

Presentation Details

Title of Presentation
Presentation Overview: Please provide a brief description of your presentation for conference program, and a more in-depth description for the program selection committee or any additional information that you feel would be relevant for the program committee in helping them understand what you will be presenting. Note: The presentation should NOT promote products or services.
Purpose-Objectives and Practical Application for your presentation:
What is the origin of this material?
If this material was originally developed by someone else, please cite the origin of material and
documentation of permission to teach.
What Phase of Ortho-Bionomy does this class entail if any?
Presentation’s relevance to the Belonging theme.
Will you be willing to adjust your presentation to a different time frame?
Will your presentation include a handout?:
Bibliography or Reference literature for your presentation (include author, title, publisher, and year):
Number of times you have made this presentation
Other information for Presentation Committee:
Autobiographical Information: Please provide a brief autobiography, including degrees and area of study. What you type in the space below will be used for the conference program. It must be typed or pasted into this space.
Did you attend the 2021 conference?
Does your presentation require a massage table?
Do you need tech assistance?
What does your virtual audience need?
Audio Visual needs? Please list what you will need ie; Projector, Easel, etc.

Please email handouts to by August 15, 2023

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