Submit A Presentation Proposal

Presentations deadline: March 14, 2008

Exhibits/Poster Sessions: Friday, August 8, 2008

PREVENTION DOMAINS

From the following list, please check all the areas your proposed presentation will address.

Planning and Evaluation
Assessing community needs
Developing a prevention plan
Selecting strategies to meet the needs of target populations
Applying sound prevention theory and practice
Identifying funding sources
Reviewing evaluation options
Conducting evaluation activities

Educational and Skill Development
Tailoring education and skill development
Connecting prevention theory and practice to plan and prepare education and skill development activities
Maintaining fidelity when replicating research-based prevention programs
Developing culturally competent education and training
Conducting skill development to meet assessed needs of audience
Educating consumers by providing accurate and appropriate information

Community Organization
Defining the community through demographics and core values
Identifying key community members
Identifying/engaging community leaders
Assessing needs and resources
Developing an outcome-based prevention plan through collaboration with members of the community
Developing the capacity of the community
Creating and sustaining community-based coalitions

Public Policy and Environmental Change
Identifying/informing policymakers
Planning public policy initiatives
Establishing a relationship with media/being a credible resource

Professional Growth and Responsibility
Attaining knowledge of current prevention theory and practice
Networking with colleagues/others in the field
Adhering to legal and professional standards
Practicing self-care consistent with personal health and wellbeing
Developing cultural competence

Please enter the following information. Please submit one presentation per application.

PRESENTER INFORMATION

Complete your name, credentials, title and organization as you would like it to appear in the printed brochure.

Lead Presenter		Co-Presenter		Co-Presenter
Name		Name		Name
Title		Title		Title
Organization		Organization		Organization
Address		Address		Address
City		City		City
State		State		State
ZIP Code		ZIP Code		ZIP Code
Phone		Phone		Phone
Fax		Fax		Fax
E-Mail		E-Mail		E-Mail
	Presentation session only - no cost		Presentation session only - no cost		Presentation session only - no cost
	Presentation one-day only - $30.00		Presentation one-day only - $30.00		Presentation one-day only - $30.00
	Entire conference - $60.00		Entire conference - $60.00		Entire conference - $60.00
	Vegeterian lunch required (may include dairy)		Vegeterian lunch required (may include dairy)		Vegeterian lunch required (may include dairy)

For school folks, please give complete summer contact information for all presenters.

PRESENTER APPLICATION

Presentation Title (as you wish it to appear in conference materials).

Presentation learning objectives (list at least 3 learning objectives)

Presentation description (75 words or less)

Explanation of program's evidence/research please site the research that supports your presentation (2-3 lines)

Presenter Biographical Sketch (2-3 lines)

Technical Level (describe your intended audience - only one)
Introductory (no subject knowledge)
Intermediate (some subject knowledge)
Advanced (extensive subject knowledge)
All audiences

Target Audience (you may choose more than one)
Youth - if your presentation addresses youth issues, please specify the age of youth it targets
Parents
Professionals

Handouts (past participants have noted that presentations are more effective and beneficial when handouts are provided)
Yes, I will bring handouts for session participants (please provide an electronic copy of your handout by October 1, 2007)
No, I will not have handouts

Style (you may choose more than one)
Panel
Interactive/audience participation
Lecture
Other

Audiovisual Equipment (check only the equipment you need)
We are NOT able to provide LCD projectors or computers. You may, however, bring in your own LCD projector and computer. MPRC and the St. Cloud Civic Center are not responsible for this equipment.
Overhead Projector
Flipchart and Markers
TV
VCR player
DVD player

Schedule Limitations
Due to a scheduling conflict, I CANNOT present on the following day:
Wednesday, October 1, 2008
Thursday, October 2, 2008

I am available to offer a repeat session:
Yes
No

Presenter Agreement

In submitting this proposal, I/we understand that MPRC does not pay for this presentation, travel, lodging, meals or other expenses associated with the conference. MPRC waives the registration fees for presenters who attend no other sessions other than their own. Each presenter who attends an additional session(s) must pay $30.00 per day.

No product or service sales are permitted in presentations; product or service sales are permitted only in exhibit booths. Presenters may not charge participants for handouts or materials.

If you have any questions feel free to call Katie Zientara (763) 427-5310 ext. 129 or email her at kzientara@miph.org

By submitting this form, I/we agree to the above conditions.

	The Minnesota Prevention Resource Center (MPRC) is a project of the Minnesota Institute of Public Health with funding provided through a grant from the Chemical Health Division, Minnesota Department of Human Services
	© Copyright 2007 Minnesota Institute of Public Health. We appreciate your comments and suggestions to help our site be more useful.