NCFAPA

Presenter Application

Agency/Organization

Presenter

Presenter Title

Co-Presenter 1

Co-Presenter 1 Title

Co-Presenter 2

Co-Presenter 2 Title

Co-Presenter 3

Co-Presenter 3 Title

Co-Presenter 4

Co-Presenter 4 Title

Co-Presenter 5

Co-Presenter 5 Title

Co-Presenter 6

Co-Presenter 6 Title

Address

City

State

Zip Code

Telephone Number
(Please include area code)

Fax Number
(Please include area code)

Email Address

Focus Area

Title of Workshop

First-Time NCFAPA Presenter

Yes No

Please Check Available Dates/Times

	Workshop Session A Friday 2:00 pm - 5:00 pm
	Workshop Session B Saturday 11:15 am - 1:15 pm
	Workshop Session C Saturday 3:00 pm - 5:00 pm
	Workshop Session D Sunday 9:00 am - 11:00 am

Maximum Class Size Preferred

Workshop Room Setup Preference*
Every effort will be made to honor your request, but it cannot be guaranteed.

	Classroom
	Theater
	Rounds
	No Preference

Audio Visual Requirements
Presenters will be supplied with standard audio visual equipment when requested in advance. This standard equipment is as follows. Items with an asterik (*) may be subject to a charge. Presenters with electronic presentations must provide their own laptop computer. Please check needed items.

	Overhead Projector/Screen
	LCD Projector and Screen *
	LCD Setup (Cart/Power/Screen)
	Microphone/Speaker System
	Wireless Microphone *
	TV/DVD Combo

Brief Bio or Resume of Presenter(s)

Abstract (Summary, Format, Audience)

Workshop Description for Brochure (LIMIT 25-75 WORDS)

Key Learning Objectives of Workshop

Enter the text you see above:

We appreciate your support which enables us to fulfill our mission!

The mission of the North Carolina Foster and Adoptive Parent Association
is to promote quality foster and adoptive services through collaborative
advocacy, education, resources, reunification efforts and networking.

2609 Atlantic Avenue, Suite 105, Raleigh, NC 27604
Phone: 1-866-623-7248
Fax: 1-919-367-9302
office@ncfapa.org
Copyright © 2011

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