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Please complete the form below in its entirety. Once it has been submitted and reviewed, the IAPFS Office will contact you regarding the status of your proposal. Thank you for supporting IAPFS!

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Contact Information for IAPFS Office

Contact Name *

Email *

Phone *

Webinar Information

Event Title *

Abstract *

Information Level (select one): *

Introductory

Intermediate

Advanced

Content Area (select one): *

For assistance, refer to https://www.asha.org/ce/understanding-continuing-education-terminology/

Related

Professional

Learning Objectives (Provide 3 outcomes):

For assistance, refer to http://2015.attendicec.org/wp-content/uploads/2015/02/ICEC.2015.USF-WritingGoodObjectives.pdf

Outcome 1 *

Outcome 2 *

Outcome 3 *

Time-Ordered Agenda *

Please provide detail on the sessions schedule by time period. Example:
5-Minutes – Introduction
25-Minutes – Case Studies
15-Minutes – Resources
15-Minutes – Question and Answer

Special Classification (If applicable):

DEI

Ethics

Supervision

Presenter Information

Presenter #1 - Name *

Presenter #1 - Credentials *

Presenter #1 - Affiliation *

Presenter #1 - Email *

Presenter #1 - Bio

#1 Financial Disclosures:

This presenter has relevant financial relationships to disclose:

Please explain:

#1 Non-Financial Disclosures:

This presenter has relevant non-financial relationships to disclose:

Please explain:

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Presenter #2 - Name

Presenter #2 - Credentials

Presenter #2 - Affiliation

Presenter #2 - Email *

Presenter #2 - Bio

#2 Financial Disclosures:

This presenter has relevant financial relationships to disclose:

Please explain:

#2 Non-Financial Disclosures:

This presenter has relevant non-financial relationships to disclose:

Please explain:

Upload Resume - Presenter #2

Presenter #3 - Name

Presenter #3 - Credentials

Presenter #3 - Affiliation

Presenter #3 - Email *

Presenter #3 - Bio

#3 Financial Disclosures:

This presenter has relevant financial relationships to disclose:

Please explain:

#3 Non-Financial Disclosures:

This presenter has relevant non-financial relationships to disclose:

Please explain:

Upload Resume - Presenter #3

Presenter #4 - Name

Presenter #4 - Credentials

Presenter #4 - Affiliation

Presenter #4 - Email *

Presenter #4 - Bio

#4 Financial Disclosures:

This presenter has relevant financial relationships to disclose:

Please explain:

#4 Non-Financial Disclosures:

This presenter has relevant non-financial relationships to disclose:

Please explain:

Upload Resume - Presenter #4

Presenter #5 - Name

Presenter #5 - Credentials

Presenter #5 - Affiliation

Presenter #5 - Email *

Presenter #5 - Bio

#5 Financial Disclosures:

This presenter has relevant financial relationships to disclose:

Please explain:

#5 Non-Financial Disclosures:

This presenter has relevant non-financial relationships to disclose:

Please explain:

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Post Test Questions (3):

Post Test Questions (attendees are required to take a post test after the presentation, please provide one true/false question and two multiple choice questions and the answers):

Post Test Question #1 *

Post Test Question #2 *

Post Test Question #3 *

References (3):

References (list at least three references used to develop this material, be sure they are in APA format and include only referenced for work published within the past 10 years): For assistance, refer to https://www.mybib.com/tools/apa-citation-generator

Reference #1 *

Reference #2 *

Reference #3 *

Do you agree to have your presentation recorded: *

YES

NO

Briefly explain why this information is important to the field (this will be used for our social media posts):

Include profile name or URL for social media sharing, if applicable:

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Photo Use Permission *

IAPFS advertises upcoming events across a variety of platforms, including email, web publications, and social media. If we can use your photo and/or profile to be used for event marketing, please indicate your consent below.

I hereby grant permission to IAPFS to use the attached photo in print and web publications, including IAPFS website, email marketing and social media.

I hereby grant permission to IAPFS to identify me using the below social meds tags/profiles for posts that include my photo or presentation information.

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To foster advocacy, research, collaboration, knowledge dissemination and support for interdisciplinary practice, in order to promote the highest standards of care for infants, children and adolescents with feeding disorders.

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