2025 ACDIS Speaker Application
This form is to collect the contact information about each proposed session and the initiating applicant. The deadline to apply is Friday, July 26, 2024.

DO NOT fill out any individual, standard fields with the information, bios, etc. for multiple people. 

Note: Materials for selected presentations will be due on February 3, 2025.

There are options at the end to list basic information for additional speakers. If your session is selected, we will follow up with all speakers for additional information. Please be assured that when a session is chosen, all speakers for a session are listed equally. 

We encourage you to click the "Save" button at the end periodically as you complete the form, and do not close the window until you complete it and click "Submit." Also, to retain a record of your submission, we recommend printing the completed form as a PDF before submitting.

Thank you! We look forward to reviewing your application!
First Name:
First Name:
Last Name:
Last Name:
Degrees/Credentials (e.g., MD, MSN, RN, CCDS, CCDS-O):
Degrees/Credentials (e.g., MD, MSN, RN, CCDS, CCDS-O):
Job Title:
Job Title:
Organization/Facility Name:
Organization/Facility Name:
City:
City:
State (abbreviation):
State (abbreviation):
Office Phone:(xxx-xxx-xxxx)
Office Phone:
(xxx-xxx-xxxx)
Email Address:
Email Address:
NOTESIf you have a special message you need to pass to us, either for the address info above or the session info below, please use this notes section vs. a required-info field. (You can return to this question as needed later.)
For which event are you interested in speaking?Please note: Speakers (up to two per session) receive registration only for the program/segment at which they are presenting (see more information in the "additional presenters" section below).
If not selected for your first-choice event, would you like to be considered for another event?
If not selected for your first-choice event, would you like to be considered for another event?
Session Title Enter a proposed session title. (Editorial staff may make changes.)
Session Title 

Enter a proposed session title. (Editorial staff may make changes.)
Session DescriptionEnter a summary paragraph or description for this session. Please be descriptive so conference attendees understand what your session will cover and how it will be useful for them.
Session Description

Enter a summary paragraph or description for this session. Please be descriptive so conference attendees understand what your session will cover and how it will be useful for them.
Learning Outcomes

Create a set of measurable learning outcomes (minimum of 3 and a maximum of 5) that each complete the following sentence: "At the completion of this educational activity, the learner will be able to ..."

For helpful information about writing effective learning outcomes, see the information we've posted at the following link: http://events.hcpro.com/app/uploads/2022/12/Tips-for-Writing-Learning-Outcomes.pdf.
Outcome #1 (required):
Outcome #1 (required):
Outcome #2 (required):
Outcome #2 (required):
Outcome #3 (required):
Outcome #3 (required):
Outcome #4:
Outcome #4:
Outcome #5:
Outcome #5:
FilesPowerPoint drafts of your proposed presentation are strongly recommended, however, applicants may also upload PDFs of supportive materials. If a draft PowerPoint is not available, providing some kind of outline of your presentation is extremely helpful in enabling us to fully and fairly evaluate your session idea. Please do not submit a past presentation on a different topic.
Files

PowerPoint drafts of your proposed presentation are strongly recommended, however, applicants may also upload PDFs of supportive materials. If a draft PowerPoint is not available, providing some kind of outline of your presentation is extremely helpful in enabling us to fully and fairly evaluate your session idea. Please do not submit a past presentation on a different topic.
 
Choose File
Speaker BioPlease include a marketing bio in paragraph form (no CVs please) we could use in the program materials for the event. It should include your current job title/responsibilities in addition to any relevant past experience. Please limit it to 100-150 words.
Speaker PhotoThe photo should be:File format JPG, TIFF, or EPS and at least 500 KB in size although we’d prefer something closer to 2 MB or even larger so that it willreproduce clearly when printed (at 300dpi)Color photo, but one that has not been enhanced or softened (e.g., not sepia tone)Full face and head view with open eyes and a natural expressionBusiness/professional attire such as a suit jacket, blouse/button-down shirt (with or without tie), sweater, etc.Please: No sunglasses, hats, or any clothing that carries advertisements and no vacation or group photosIf you will be taking a new photo to send to us we recommend the following:A plain white, off-white, or gray backgroundNormal contrast and lighting (not in front of a bright window)Avoid shadows on the face or background
Speaker Photo

The photo should be:
  • File format JPG, TIFF, or EPS and at least 500 KB in size although we’d prefer something closer to 2 MB or even larger so that it will
  • reproduce clearly when printed (at 300dpi)
  • Color photo, but one that has not been enhanced or softened (e.g., not sepia tone)
  • Full face and head view with open eyes and a natural expression
  • Business/professional attire such as a suit jacket, blouse/button-down shirt (with or without tie), sweater, etc.
  • Please: No sunglasses, hats, or any clothing that carries advertisements and no vacation or group photos
If you will be taking a new photo to send to us we recommend the following:
  • A plain white, off-white, or gray background
  • Normal contrast and lighting (not in front of a bright window)
  • Avoid shadows on the face or background
 
Choose File
Please specify why you are qualified to speak on your proposed topic.
Please specify why you are qualified to speak on your proposed topic.
List any previous speaking or presentation experience.
List any previous speaking or presentation experience.
Will Your Session Have Any Additional Presenters?If you answer yes, you will be able to add information for two additional presenters below, but ACDIS will provide complimentary conference registrations only for a total of two speakers for each standard session. Your team can decide who would receive the complimentary registrations. NOTE: Having additional presenters is optional, but the names and basic contact details of all intended speakers for your session should be submitted as part of this application. If your session is accepted and you then decide it is necessary for you to add a co-presenter (or update the list of whomever was originally submitted), approval for the session change will be at ACDIS's discretion and will need to be confirmed before you invite them.
Will Your Session Have Any Additional Presenters?

If you answer yes, you will be able to add information for two additional presenters below, but ACDIS will provide complimentary conference registrations only for a total of two speakers for each standard session. Your team can decide who would receive the complimentary registrations.

NOTE: Having additional presenters is optional, but the names and basic contact details of all intended speakers for your session should be submitted as part of this application. If your session is accepted and you then decide it is necessary for you to add a co-presenter (or update the list of whomever was originally submitted), approval for the session change will be at ACDIS's discretion and will need to be confirmed before you invite them.
Co-presenter 1 BioPlease include a marketing bio in paragraph form (no CVs please) we could use in the program materials for the event. It should include the co-presenter's current job title/responsibilities and credentials in addition to any relevant past experience. Please limit it to 100-150 words.
Co-presenter 1 photoThe photo should be:File format JPG, TIFF, or EPS and at least 500 KB in size although we’d prefer something closer to 2 MB or even larger so that it willreproduce clearly when printed (at 300dpi)Color photo, but one that has not been enhanced or softened (e.g., not sepia tone)Full face and head view with open eyes and a natural expressionBusiness/professional attire such as a suit jacket, blouse/button-down shirt (with or without tie), sweater, etc.Please: No sunglasses, hats, or any clothing that carries advertisements and no vacation or group photosIf you will be taking a new photo to send to us we recommend the following:A plain white, off-white, or gray backgroundNormal contrast and lighting (not in front of a bright window)Avoid shadows on the face or background
Co-presenter 1 photo

The photo should be:
  • File format JPG, TIFF, or EPS and at least 500 KB in size although we’d prefer something closer to 2 MB or even larger so that it will
  • reproduce clearly when printed (at 300dpi)
  • Color photo, but one that has not been enhanced or softened (e.g., not sepia tone)
  • Full face and head view with open eyes and a natural expression
  • Business/professional attire such as a suit jacket, blouse/button-down shirt (with or without tie), sweater, etc.
  • Please: No sunglasses, hats, or any clothing that carries advertisements and no vacation or group photos
If you will be taking a new photo to send to us we recommend the following:
  • A plain white, off-white, or gray background
  • Normal contrast and lighting (not in front of a bright window)
  • Avoid shadows on the face or background
 
Choose File
Co-presenter 2 BioPlease include a marketing bio in paragraph form (no CVs please) we could use in the program materials for the event. It should include the co-presenter's current job title/responsibilities and credentials in addition to any relevant past experience. Please limit it to 100-150 words.
Co-presenter 2 photoThe photo should be:File format JPG, TIFF, or EPS and at least 500 KB in size although we’d prefer something closer to 2 MB or even larger so that it willreproduce clearly when printed (at 300dpi)Color photo, but one that has not been enhanced or softened (e.g., not sepia tone)Full face and head view with open eyes and a natural expressionBusiness/professional attire such as a suit jacket, blouse/button-down shirt (with or without tie), sweater, etc.Please: No sunglasses, hats, or any clothing that carries advertisements and no vacation or group photosIf you will be taking a new photo to send to us we recommend the following:A plain white, off-white, or gray backgroundNormal contrast and lighting (not in front of a bright window)Avoid shadows on the face or background
Co-presenter 2 photo

The photo should be:
  • File format JPG, TIFF, or EPS and at least 500 KB in size although we’d prefer something closer to 2 MB or even larger so that it will
  • reproduce clearly when printed (at 300dpi)
  • Color photo, but one that has not been enhanced or softened (e.g., not sepia tone)
  • Full face and head view with open eyes and a natural expression
  • Business/professional attire such as a suit jacket, blouse/button-down shirt (with or without tie), sweater, etc.
  • Please: No sunglasses, hats, or any clothing that carries advertisements and no vacation or group photos
If you will be taking a new photo to send to us we recommend the following:
  • A plain white, off-white, or gray background
  • Normal contrast and lighting (not in front of a bright window)
  • Avoid shadows on the face or background
 
Choose File