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Presenter Application

I have read and understand all the information in the Call for Presentations.
* Asterisk indicates required fields.
Primary presenter information
*Contact First Name:
*Contact Last Name:
*Title:
*Organization/Agency Name:
*Address:
*City:
*Country:
*State/Province: If not applicable, please enter N/A.
*Zip/Postal Code:  If not applicable, please enter N/A.
*Phone Number:
Cell Number:
*E-mail Address:

Please check here for the second presenter information

Please complete all the requested information

Session title
Write a title that describes the content of the session. The title can be no longer than 10 words.
If your sessions involves business management, marketing, employee wellness or career development please go directly to the session description.
If your session focuses on working with older adults, what level of PHYSICAL function will the content be aimed at? Select the 3 that best describes the older adults.
High-functioning; exercises or has physically demanding job
Functions well; physically active in household work or exercise
Physically able to perform daily activities; limited fitness
Poor fitness level; physical limitations; may need assistance
Frail; needs assistance to perform activities of daily living
If your session focuses on working with older adults, what level of COGNITIVE function will the content be aimed at? Select the 3 that best describes the older adults.
Normal cognitive function, no evident deficits
Some cognitive impairment, but still functioning well and living independently
Cognitive impairment, needs some help from family or staff
Clear-cut cognitive decline requiring support from family or caregivers
Diagnosed dementia; does not live independently
Abstract/Session description
Write a description detailing what attendees will learn at your session. Limit to 150 words.
Be as specific as possible with session outcomes.
Do you have experience facilitating interactive group sessions?
Yes
No
If yes, where and when?
What is the primary dimension of wellness covered in this session?
Learning objectives
List three objectives, which are required to obtain CEUs for our delegates.
(Please describe specific outcomes for attendees by listing what individuals will be able to do following your session, rather than what they will learn or what you plan to teach them.)
By the end of this session, attendees will be able to:
1.
2.
3.
How will ICAA delegates implement your session content?
This content is also available for a webinar
Yes
No
Primary presenter biography
Please provide a biography (50 words) that includes your academic credentials, title and experience.
Conference track
Presentation format
Lecture only
Lecture and physical activity
Panel session
Roundtable discussion
Primary presenter experience
What is your past experience as a presenter?
No prior experience
1 - 5 presentations
6 or more presentations
How many years of experience do you have working with older adults, or teaching people who work directly with older adults?
0 to 2 years experience with older adults
3 to 7 years experience with older adults
8 years or more experience with older adults
Equipment requirements for activity based sessions
If your session requires equipment, please provide the specific pieces and quantity needed. If the session is selected, ICAA will contact the presenter to discuss equipment needs. ICAA may be able to provide limited equipment but cannot guarantee this. Presenters are able to provide their own exercise/activity equipment, at their expense, after consulting with ICAA.
Audiovisual requirements
Please list specific and total audiovisual equipment required for the session. Microphones are provided. Due to costs, Internet connections are not available. If you order ANY audiovisual on site, including laptops, you will be invoiced for the cost.
Data projector (presenters provide own laptop and remote control for changing slides)
Flip chart with markers
No audiovisual required
Additional:
Primary Presenter Acknowledgement
  1. I understand that presenters at Active Aging conferences receive a complimentary registration to all conference activities.
  2. I am responsible for all expenses, including travel and accommodations.
 

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