2018 NIEAPA Conference Presenter Proposal Form
40th Annual Conference
Tuesday, June 5, 2018
Drury Lane Conference Center, Oakbrook Terrace, IL

NIEAPA Conference attendees include employee assistance program managers, benefit managers, clinical psychologists, medical directors, social workers, counselors and community liaisons. The Conference is an excellent opportunity to connect with the EAP community and raise awareness of topics or issues about which you believe the community would be interested in learning.

Please note that this online form does not allow you to save your responses and reopen at a later date to complete. If you prefer a form you can print out and complete please contact Jodi Whitlock at 312-756-7756 or NIEAPA@corpevent.com.

Forms are due Friday, December 22, 2017.
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Title: *
Ten words or less
Presentation Format
Please check one *
Topic Area *
Skill Set and Levels
*
Beginner
Intermediate
Advanced
EAP Counselor
Account Management
Marketing and Sales
Presenter(s) - if more than two presenters, please list name and contact information of third presenter under Notes section at the end of this form.
Name *
Credentials
Title
Organization *
Address, City, State, Zip
Email *
Phone Number *
Fax Number
Second Presenter
Name
Credentials
Title
Organization
Email
Phone Number
Contact information for whomever should receive communications
Name *
Email *
Phone *
Fax
Description of Presentation
Brief Description of the Proposed Session. *
Provide a brief description of the proposed session. Your description will be the template for the description published in the conference brochure and used by participants to select sessions. Please be thoughtful and concise.
Learning Objectives *
In order for your proposal to be considered, you must list the specific learning objectives for the session. Please be consistent with selected presentation format and participant level. Do not attempt to include too much information into shorter sessions.
Outline *
How will you structure your presentation? (i.e. lecture, discussion. video, group exercises, case studies) If you will need audiovisual support, please list your requirements here. (Projector. laptop and microphones are provided. Additional A/V equipment may be available at the expense of the presenter)
CV and Biography
Curriculum Vitae or Resume *
Or email to Jodi Whitlock - nieapa@corpevent.com. If you are emailing please type in "Email" in the response box below.
Brief Biography *
Or email to Jodi Whitlock - nieapa@corpevent.com.  If you are emailing please type in "Email" in the response box below.
References
Please list the names, telephone numbers and email addresses of at least three people who can discuss your ability to speak about your proposed topic.
Name of 1st Reference *
Title/Organization
Email *
Phone *
Name of 2nd Reference *
Title/Organization
Email *
Phone *
Name of 3rd Reference *
Title/Organization
Email *
Phone *
Persons who are selected to present are invited to join us for lunch and are encouraged to spend the day attending the Conference as our guest. NIEAPA asks that you refrain from promoting your business or services as part of your presentation at the Conference.
Notes
Please Include Any Additional Notes Here
Email/Signature of Presenter(s) *
Date *
Proposal deadline is Friday, December 22, 2017.
Thank you for your interest in the NIEAPA 2018 Conference

Conference Chair: Donald Mitckess, LCPC
                                 Recovery Works


If you have any questions about this form, please contact Jodi Whitlock at 312-756-7756 or nieapa@corpevent.com
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