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PRESENTER / PANELIST / MODERATOR REQUEST FORM


Return completed form on or before WEDNESDAY, JANUARY 31st
to ESI Management Group - tia_esimgt@msn.com

List My Contact Information In The Conference Packet
AUDIO-VISUAL NEEDS**
Will you be preparing / using a power-point presentation?
Will you be preparing / using other materials for attendees?

**Please send your power-point presentations and/or other non-copyrighted ‘handouts’ by APRIL 26th to esi@esimgt.com so they may be posted & ready for attendees to follow during your presentation. Then, bring your presentation on your laptop so you can use and reference your materials as you present. (If you will be including anything from the web, be sure to have that embedded in your presentation so there are no issues with wi-fi connections during the livestream and recording of your presentation.)

TEACHING METHODS and/or MATERIALS YOU PLAN TO PROVIDE / USE (Please check all that apply)
RISK
(IF ANY) TO ATTENDEES WHO APPLY WHAT IS LEARNED AND/OR THEIR PATIENTS. (Required for APA Program Approval):
PLEASE PROVIDE A BRIEF DESCRIPTION OF YOUR PRESENTATION. THIS DESCRIPTION WILL BE COMBINED WITH YOUR OBJECTIVES & SERVE AS AN ENTICEMENT TO DRAW PEOPLE N WILL BE COMBINED WITH YOUR OBJECTIVES & SERVE AS AN ENTICEMENT TO DRAW PEOPLE. Please try to include the main ‘take-away’ tools you will give attendees and the level(s) of practitioners for whom your presentation is targeted (beginning, intermediate, advance).(ESI may edit for program and space purposes.)
OBJECTIVES

As a presenter at GENERATIONS 2024, I do hereby agree to conduct a presentation as detailed above and in the letter of confirmation. I also agree to ensure that my participation is free of slanderous statements, that I will not hold any other parties liable for my comments, and that I will not utilize someone else’s written materials without their permission. In so doing, I also agree to indemnify, hold harmless and defend the partners and organizers of this meeting for actions that may result from my participation.