Call for Presentations Submission Form

Lead Speaker

First Name:	required
Last Name:	required
Organization:	required
Address:	required
	required
	required
City:	required
Province:	Alabama Alaska Alberta Arizona Arkansas British Columbia California Canal Zone Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Labrador Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territorie Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Vulcan Washington West Virgina Wisconsin Wyoming required
Postal Code:	required
Phone:	required
Fax:
Email:	required

Please provide a short bio (50 words each) including name, title, organization and knowledge and experience related to the presentation topic.
Speaker Bio:
Additional Speaker information will be collected on the following page. If there are no additional speakers please select '0' from the drop down below.
Additional Speakers?	0 1 2 3 4 5 6 7 8 9 10 required

1. Presentation Title

Use a title (8 – 10 words) that is informative and reflects the content of your presentation (may be edited during brochure production).
Presentation Title:	required

2. Education Streams

Indicate which stream your presentation best represents (select only one).
	Care and Services
	Integration and Collaboration
	Management and Operations
	Governance and Leadership

3. Relevance of Presentation

Indicate how your presentation addresses the stream identified above.
Relevance of Presentation:	required

4. Target Audience

Indicate who will benefit from attending your presentation (select all that apply):
	Administration / Governing Body
	Nursing
	Food & Nutrition
	Housekeeping/Laundry
	Human Resources
	Environmental Services
	Information Technology
	Board / Governing Body
	Housing
Other:	(please specify)

5. Presentation Description

Please provide a summary (100 – 250 words) of your presentation (will be edited during brochure production).
Description:	required

6. Learning Outcomes

List three main educational goals of your presentation that reflect what participants will learn as a result of participating.
Outcome #1:
Outcome #2:
Outcome #3:

7. Presentation Format

Please select the education method(s) your presentation will incorporate (select all that apply).
	Lecture
	Interactive presentation/discussion
	Interactive panel presentation
	Group work/roundtable discussions
	Case studies/facilitated brainstorming
	Audio visuals
	Story telling/role playing

8. Audio Visual Requirements

Please select the equipment you require for your presentation.
	N/A
	LCD projector and screen (you must bring your own laptop computer)
	Overhead Projector and screen
	Microphone:   Podium Hand-held Clip-on
	Flipchart and markers
Other:	(please specify)

9. Speaker Availability

Education sessions will be held in the morning and afternoon on Tuesday June 8 and Wednesday June 9. Please indicate your availability below.
	Tuesday June 8 only
	Wednesday June 9 only
	Both June 8 and June 9

The deadline for submissions is January 4, 2010.

Please note that the Call for Presentations submission must be completed online.

OANHSS does not generally provide fees or honorariums for speakers or cover travel or other costs. Exceptions may be granted at the discretion of the Association.

All speakers will be recognized on the OANHSS website in the speaker resource section, which will list your name, business telephone number and email address for OANHSS members to access. If you wish to have any of this information withheld, please contact Nina Zivkovic at (905) 851-8821 ext. 246 or nzivkovic@oanhss.org.