SMHCA Presentation Proposal Form Note that trainings are generally scheduled for the 3rd Friday of every month from 1:30-4:30 pm ET Question Title * 1. Primary Presenters's Contact Information Presenter Name and Credentials Company, Agency, or Organization Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 2. Name(s) of Co-Presenters (if applicable) Question Title * 3. Title of Webinar Question Title * 4. Brief Description of Webinar (written to attract mental health professionals) To describe your learning objectives, create statements that indicate what the attendees will/should be able to do after your presentation. You may use these terms: list, state, explain, describe, differentiate, discuss, calculate, compare, contrast, choose, define, demonstrate, estimate, evaluate, locate, match, name, plan, predict, rank, recommend, select, summarize, write, etc. Please do not use these terms: know, learn, appreciate, value, acquire, comprehend, be familiar with, recognize, understand, etc. Examples of Learning Objectives: Locate free assessment measures online. Differentiate between malingering and Factitious Disorder. Summarize four principles of motivational interviewing. List signs and symptoms of an alcohol use disorder. Define "introversion" and "extroversion." Match clients to appropriate levels of care. Evaluate clients for suicidal risk. Question Title * 5. List 3-4 Learning Objectives for the Webinar Objective 1 Objective 2 Objective 3 Objective 4 Question Title * 6. Brief Bio of Presenter (used to introduce the presenter and to promote the webinar): Question Title * 7. Are you a member of Florida Mental Health Counselors Association? Yes No Question Title * 8. Are you a member of the Suncoast Mental Health Counselors Association? Yes No Question Title * 9. Please upload a headshot photo we can use to promote the webinar (JPG, GIF, or PNG format) GIF, PNG, JPG, JPEG file types only. Choose File Choose File No file chosen Remove File Please upload a headshot photo we can use to promote the webinar (JPG, GIF, or PNG format) Question Title * 10. Please upload a copy of your resume or CV PDF, DOC, DOCX file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your resume or CV TERMS Payment: SMHCA will credit the presenter appropriately in all promotional materials related to the webinar. Presenters shall not be entitled to any reimbursement or honorarium for this webinar from any source unless agreed upon in writing with SMHCA. Copyright and Ownership:The Presenter represents and warrants that all presentations are original works created solely by the Presenter, except for public domain material that may be incorporated therein. To the extent that the presentations contain any material or excerpt from the works of others, the Presenter shall ensure that it is done with full right and authority, and may be reused as detailed in this Agreement. It is the Presenter’s obligation to obtain all necessary releases, waivers, licenses, and other permission required for the full performance of Presenter’s obligations under this Agreement and to provide such materials to SMHCA. SMHCA will be the sole copyright owner of the recorded webinar in its entirety. The Presenter grants SMHCA an exclusive license right, title, and interest in and to the presentation, including all licenses to copyrights embodied therein for the purpose of the SMHCA educational program. SMHCA may record the training, provide the recording to attendees, incorporate the training in its "On Demand" training program, and promote the "on demand" version of the training on its website, social media pages, and other organizational platforms. Question Title * 11. By typing my signature below, I am offer an electronic signature attesting to my agreement with the above terms. Next
