CALL FOR PROPOSALS
2014 CLINICAL NUTRITION MANAGEMENT DPG SYMPOSIUM
Empowering Yourself for Success
April 5 – April 8 2014
Grove Park Inn
Ashville, North Carolina 28804
Symposium Session Information Form
Session Title:
SESSION DETAILS:
*SUGGESTED PRIORITY CDR
CPE LEARNING NEED CODE:
Other possible codes OR
*see Directions for list of codes
PREFERRED SESSION DAY: Please numerically rank (1-4) the order of the days you prefer your proposed session to be scheduled based on availability. The CNM Professional Development Team will attempt to accommodate scheduling requests, but reserves the right to assign sessions based on programming needs.
Saturday SundayMondayTuesday
Objectives: (maximum 3): This information should complete the following statement, “After this presentation, the attendees will be able to:”
1.
2.
3.
Session Outline:Please briefly describe each speaker's topic as it relates to the symposium's overall objectives. Include the extent to which this session contributes new and/or significant information.
EQUIPMENT NEEDED FOR PRESENTATION
Presentation Format:
Interactive Instruction
Workshop
Skill set development – Core Concepts with Participant Interaction Activity
Storytelling, Action Learning
Lecture
DESCRIPTION (Focus Statement) Write 2-3 sentences explaining the rationale for presentation to Clinical Nutrition Managers and other attendees. This statement may be used as supportive promotional materials for the session and should be reflective of the previously stated objectives.
CNM SYMPOSIUM speaker reimbursement policy
- Dietetic professionals selected to speak will receive complimentary registration to the annual symposium and reimbursement against travel expenses of up to $970, with the exception of sponsorship or vending.
- In order to encourage additional professional proposals, non-dietetic professionals will receive complimentary registration and agreed upon honorarium.
- No more than 1 speaker per session will be eligible for the speaker reimbursement against travel.
1st Speaker Biographical Sketch & Release of Contact Information
This information must be completed to assist your presiding officer in writing your introduction and to verify that our information is accurate for publication. You mayinclude curriculum vitae.
First Name Initial Last Name
Credentials/Degrees
Presenter at CNM Symposium 2012 ___ yes no Presenter at CNM Symposium 2013yes no
Position Title
Place of Employment
Contact Information:
Street ______City ______State ______Zip ______
Phone number ______Cell Phone number______Fax Number: ______
E-mail address: ______
Recent career highlights:
______
Previous speaking experience (please provide titles, audience size, and audience composition):
______
Qualifying experience enabling you to speak on your topic (one sentence or short example):
______
Reimbursement Request:
Dietetic Professional (complimentary registration and up to $970 expense reimbursement provided). If more than 1 speaker submitting to speak, please indicate which one will receive reimbursement against travel.
Academy member? Yes No Registration number? ______
CNM Member? Yes No
Non-Dietetic Professional (complimentary registration and honorarium). Please list requested honorarium:
Would you be willing to write an article for the CNM DPG Newsletter based on your proposal? Yes No
For questions or assistance, please contact Kelly Danis, Professional Development Committee Chair at or, Kathy Allen Chair Elect at
2nd Speaker Biographical Sketch & Release of Contact Information
This information must be completed to assist your presiding officer in writing your introduction and to verify that our information is accurate for publication. You mayinclude curriculum vitae.
First Name Initial Last Name
Credentials/Degrees
Presenter at CNM Symposium 2012 ___ yes no Presenter at CNM Symposium 2013yes no
Position Title
Place of Employment
Contact Information:
Street ______City ______State ______Zip ______
Phone number ______Fax Number: ______
E-mail address: ______
Recent career highlights:
______
Previous speaking experience (please provide titles, audience size, audience composition):
______
Qualifying experience enabling you to speak on your topic (one sentence or short example):
______
Reimbursement Request:
Dietetic Professional (complimentary registration and up to $970 expense reimbursement provided). If more than 1 speaker submitting to speak, please indicate which one will receive reimbursement against travel.
Academy member? Yes No Registration number? ______
CNM Member? Yes No
Non-Dietetic Professional (complimentary registration and honorarium). Please list requested honorarium:
Would you be willing to write an article for the CNM DPG Newsletter based on your proposal? Yes No
For questions or assistance, please contact Kelly Danis, Professional Development Committee Chair at or, Kathy Allen, Chair Elect at