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2277 Highway 36 West, Suite 200 Roseville, MN 55113-3830
Phone: 612-378-2742
Toll Free: 1-800-669-6442
Fax: 612-378-2789
E-Mail:info@braininjurymn.org
Hours: Monday-Friday, 8 a.m. to 4:30 p.m.

Conference RFP

Please use this form to submit information on your presentation. Presentations should reflect the overall Conference theme. All breakout sessions are 60 minutes in length. Submissions must be typed. You may have up to four presenters in your presentation. One person must be identified as the Lead Presenter; each presenter must supply their contact information in addition to a résumé or vitae. The deadline for applications is November 18, 2017.

About Handout Materials
For accepted proposals, the Lead Presenters must supply an electronic version of their presentation (by disk or e-mail) by March 10, 2018. All materials will be provided to participants by posting them on our website. If hard copies are preferred, the Lead Presenter is required to provide these.

Topics to Consider
Topics of Particular Interest to the Planning Committee include: Moving from Childhood Brain Injury into Adulthood; Going to College; Aging and Brain Injury; Co-Occurring Issues; Accessing County Services; Veterans and Brain Injury; Sensory Impairments following Brain Injury; Brain Injury and Domestic Violence; Brain Injuries caused by Sports Concussion; Secondary Stroke Prevention, Understanding the Intersection of Brain Injury and Stroke; Sexuality and Dating; Rehabilitation and Recovery of Brain Injury and Stroke; Quality of Life after Brain Injury.

Presenter Agreement
Solo presenters will receive complementary registration for the day they are presenting. Presenters part of a panel presentation receive a reduced conference admission for the day they are presenting. Submission of a presentation proposal indicates understanding that presenters volunteer their participation in the Annual Conference for Professionals in Brain Injury. Travel, lodging, meals and any other expenses incurred by the presenter(s) also are their responsibility.

If You Have Questions
Please contact the Education and Community Outreach Manager at the Minnesota Brain Injury Alliance at 612-378-2742 or 800-669-6442. If you have any problems with this form, please e-mail us.

Presentation Information
Title of Presentation:*
Three Objectives of Presentation: (1, 2, 3)*
Description: (50 words or less)* (this description will be used in printed materials - please limit to 50 words)
Lead Presenter Name:* (all communications will be made through the Lead Presenter)
Job Title:*
Employer:*
Address:*
City:*
State:*
Zip:*
Day Phone:*
Cell Phone/Alternate Phone:
E-mail:*
Preferred method of contact*
E-mail Phone
Biography:

About Your Presentation
Would you be willing to present your breakout session twice? *
Yes No
Could your presentation have Part I and Part II? *
Yes No
Audio-Visual Instructions:
Presenters are expected to supply their own laptop if it is needed for their presentation. Please check which items you will require:
Charges may be billed for any unplanned day-of arrangements of items.
If you are the only presenter, click on the "Submit" button below. Otherwise, please continue filling out this form with additional presenters.

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Presenter 4 Name:
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