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* 1. Presenter Information

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* 2. Are you a PDC member?

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* 3. Please provide contact information for a PDC reference:

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* 4. Program Title:
(please limit to 100 character or less, this is so that your title will fit on the website and app)

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* 5. Program Description:
(please limit to 500 words or less)

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* 6. Describe at least three learning objectives:

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* 7. Please describe the extent to which your session aligns with at least one of the PDC’s goals and strategic priorities including:
1. Member Engagement - to help ensure that all PDC members feel seen, included, engaged, and valued.

2) DEIB - to positively effect change for both Diversity, Equity, Inclusion & Belonging and social impact within our profession and beyond.

3) Thought Leadership - to provide a voice for our profession and amplify the reach of our members.
(please limit to 500 words or less)

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* 8. Please select the best category for the program. (Please note this is for planning purposes only.)

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* 9. Please describe at least one concrete resource (examples may be a handout, checklist, or copy of presentation slides) that participants will receive participating in your session:

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* 10. Target Audience (This program is most appropriate for):

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* 11. What is the ideal program duration (please select all that apply):

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* 12. What interactive components do you plan to incorporate into your method of delivery (select no more than 3):

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* 13. Will you have one or more co-presenters?

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* 14. Co-Presenter #1 Information (if applicable):

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* 15. Is the Co-Presenter #1 a PDC Member?

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* 16. Co-Presenter #2 Information (if applicable):

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* 17. Is the Co-Presenter #2 a PDC Member?

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* 18. Have you or any of your co-presenters previously presented at a PDC Conference?

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* 19. If yes, when:

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* 20. Do you agree that if selected to present at the conference you will be responsible for registration, hotel, and travel costs without remuneration by the PDC?

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* 21. If you selected "No,” please use the below to provide any comments or questions regarding the terms for presenting at the conference and/or request scholarship information.

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