NBCDI - Online Application

1313 L Street, NW
Suite 110
Washington, DC 20005-4110
P: (202) 833-2220
F: (202) 833-8222
E: moreinfo@nbcdi.org

Please complete the on-line application below. (Asterisks denote required fields).

Please note that you can not save the proposal and edit it later. Once the proposal is submitted, you can not retrieve it.

Presentation

Title*

Audience Served*

Workshop Category*

Permission to Record*

Yes
No

Please enter a Workship Overview below. It should be a maximum of 70 words and contain engaging and descriptive language for the conference program.

Overview
(70 words max)*

Abstract

Please enter an abstract for your workshop below. It must have sufficient descriptive information about your presentation, including the major points, objectives, three learning outcomes, and the format of the presentation.

Abstract*

Presenters

Please enter the lead presenter for the workshop, and up to three secondary presenters.

Presenters

Lead Presenter

Prefix*

First Name*

Middle Initial

Last Name*

Suffix

Email*

Organization*

Job Title*

Address*

Address 2

City*

State*

Zip*

Primary Phone*

Secondary Phone

Fax

Biographical Info*

Co-Presenter

Prefix*

First Name*

Middle Initial

Last Name*

Suffix

Email*

Organization*

Job Title*

Address*

Address 2

City*

State*

Zip*

Primary Phone*

Secondary Phone

Fax

Biographical Info*

Co-Presenter

Prefix*

First Name*

Middle Initial

Last Name*

Suffix

Email*

Organization*

Job Title*

Address*

Address 2

City*

State*

Zip*

Primary Phone*

Secondary Phone

Fax

Biographical Info*

Co-Presenter

Prefix*

First Name*

Middle Initial

Last Name*

Suffix

Email*

Organization*

Job Title*

Address*

Address 2

City*

State*

Zip*

Primary Phone*

Secondary Phone

Fax

Biographical Info*