CSGNA 2018 Speaker Information Form Question Title * 1. Session Title Question Title * 2. Speaker (enter position and organization as you would like them listed in the program) Name Position Organization Email Phone Question Title * 3. Audio-Visual EquipmentPresentation rooms will be equipped with a full set up for powerpoint presentations (laptop and projector). Please bring your powerpoint presentation to the Conference on a USB flashdrive to load onto the laptop provided onsite. An a/v technician will be present to help load the presentations.Please specify any additional equipment required (subject to budget & availability): Question Title * 4. Learning ObjectivesAll speakers should submit the learning objectives. These will be included on the website and are required for CLE. If you are a speaker in a session with more than one presenter, please confer with the Chair of your session to clarify the general objectives for the session, and submit the learning objectives for your specific presentation. The objectives should be written from the perspective of the learner, descriptive of what the learner will gain in knowledge, skills and attitudes as a result of participating in the event; and written to enable evaluation of achievement by the planners and participants. Please use verbs that denote an observable action, such as “list, explain, summarize, discuss, compare, etc.” NOTE: It is NOT permissable to use words that indicate emotions or feelings such as “know, learn, appreciate, understand, recognize, etc.” For a list of actionable words, please reference this link. 1 2 3 4 5 6 Question Title * 5. Description: Please provide a summary of your presentation. At the end of your summary please indicate your target audience, for example, “The session will be of value to: IBD, Educators, Students etc....” Question Title * 6. Biography: Please provide a short bio (1-2 paragraphs) Question Title * 7. The CSGNA can make my presentation available to individuals who may be interested in accessing it by posting it on their national association website. Yes No Comment: Question Title * 8. Speaker Signature and Date: I, the undersigned, the author of this presentation, certify that I have obtained all customary and necessary permission to use and print any copyright material that appears in my presentation. Speaker Name Date Done