Thank you for your interest in Iris House's 12th Annual Women as the Face of AIDS Summit. This year's theme is "Resilient, Fierce and Wise!"

This is the online application to propose a session you want us to consider for the program.  You may submit more than one.

Please fill out this survey as fully as possible to help us communicate with you and put together our journal as fully as possible. We will be using the information here for marketing purposes and for logistic needs and issues at the Summit itself.

If you have any questions now, or throughout this process, please contact Michael Barret Jones, Iris House's Director of Development, Advocacy and Social Marketing at mjones@irishouse.org or 646-548-0100 x222

Thank you!

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1. What Organization Do you Represent?  (if none, please indicate.)

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2. Under What Topic Track do you wish to be considered?

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3. What is the full title of your session?

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4. Due to long session titles, we may need to truncate yours to fit in allotted space. Would you please give us a shortened version (approximately 30-40 characters) to use in marketing materials? (The full version you listed above will appear in the journal proper.)

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5. What is the format of Your Session?

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6. How many presenters/panelists do you expect to use?

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7. Please list your presenters, with titles and organizations exactly as you would like it listed in the journal. For example, "Ingrid N. Floyd, M.B.A., Executive Director and Michael Barret Jones, Director of Development, Iris House."

If more than one person represents the same organization, you may put the organization once at the end.

If you have a panel, please include the names and affiliations of all panelists. If you do not know all names, please use all that you know and add "and other speakers" at the end.

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8. What is the Expected Audience for Your Session?

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9. OBJECTIVE:  Describe the purpose of the session and what outcomes you hope from your audience at the Summit

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10. METHODS:  Briefly describe the information you'll be addressing, and the methods or strategies used in the program.

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11. RESULTS:  Describe the objective outcomes of the program, project or study. Include quantifiable data, if possible.

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12. TAKE AWAYS:  State the conclusions reached as a result of the program, or what you want your audience to go away with.

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13. Lead Contact's Email Address

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14. Additional Presenter's Email Address

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15. Additional Presenter's Email Address

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16. Additional Presenter's Email Address

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17. Please list a cell phone number that we may use to reach you on the day of the Summit. (Only one per group required.)

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18. Do you and/or your organization have a Twitter handle that you'd like us to use in pre-event publicity and/or day of tweeting?

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19. Would you like us to put anyone else at your organization on the list to receive information? (Your Executive Director or Board Chair, for example?) Please list their name and email address below.

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20. Will you be using a visual aid to augment your presentation? (Please be aware that we highly recommend and prefer presentations to be in Microsoft PowerPoint Format, and that unless otherwise discussed, we will make pdf's of all presentations available after the Summit on Iris House's website. Please also note that Iris House will set up all A/V materials ahead of time and that we require presentations to be sent to us by email on or before Monday, April 1, 2017.)

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21. Please indicate your A/V needs for the day of the Summit.

(Please note that this year's venue has smaller rooms than in the past, and that microphones may neither be required nor available for all spaces.)

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22. If you and your presentation team intend to attend the luncheon, please indicate the number of seats you will require.

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23. Do you have any other questions or needs that we can help you with?

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