PACN-ED-2027 Conference Presenter Application

Presenter Information

First Name*

Last Name*

Credentials

Email (Please use the same email used in your AAPACN account.)*

Phone Number*

Job Title*

Company Name*

Address 2: Street 1

Address 2: City

Address 2: State

Address 2: Zip/Postal Code

Address Type

Professional Experience*

Daily Job Duties

Presenter's Professional Bio (Limit to 175 words)*

Presenter's Previous Speaking Experience (Include in-services, state, or national conferences, etc.)*

Reference (If you are a first-time AAPACN presenter, please provide at least one reference who can attest to your experience as a presenter. List the name, email, phone number, and relationship to you.)

Presenter Photo (Please upload a professional photo that may be used in conference promotional materials.)*

Co-presenter Information (Only for Sessions with Co-presenter)

Co-presenter Name

Co-presenter Credentials

Co-presenter Job Title

Co-presenter Company Name

Co-presenter Email

Co-presenter Phone

Co-presenter Street Address

Co-presenter City/State

Co-presenter Zip Code

Co-presenter Professional Experience

Co-presenter Professional Bio (Limit to 175 words)

Co-presenter's Previous Speaking Experience (Include in-services, state, or national conferences, etc.)

Co-presenter Reference (If you are a first-time AAPACN presenter, please provide at least one reference who can attest to your experience as a presenter. List the name, email, phone number, and relationship to you.)

Co-Presenter Photo (Please upload a professional photo that may be used in conference promotional materials.)