Stevie JoEllie's Cancer Care Fund's Speaker Proposal Forms

1. Stevie JoEllie’s Cancer Care Fund’s Annual Thyroid Cancer Survivors
Reunion and Celebration of Life Sept. 1st -8th 2012
Speaker/Presentation Application/Proposal
Deadline for Submission: May 20, 2012
Email: steviejoelliescancercarefund@gmail.com
Subject Line: Speaker Proposal
Presenter Name
Presenter Designation
Page | 1
Presenter Job Title
Organization Name
Mailing Address
City
State / Providence
Zip / Postal Code
Country
Telephone
Fax
Email
Website
Blog
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2. Stevie JoEllie’s Cancer Care Fund’s Annual Thyroid Cancer Survivors
Reunion and Celebration of Life Sept. 1st -8th 2012
Speaker/Presentation Application/Proposal
Deadline for Submission: May 20, 2012
Email: steviejoelliescancercarefund@gmail.com
Subject Line: Speaker Proposal
Co-Presenter Name
Co-Presenter Designation
Page | 2
Co-Presenter Job Title
Presentation Title
Session Description
Note: This description will be
used for promotional
purposes and should be a
complete and detailed
description in 75 words or
less that fully describes your
topic content.
Learning Objective 1
Learning Objective 2
Learning Objective 3
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3. Stevie JoEllie’s Cancer Care Fund’s Annual Thyroid Cancer Survivors
Reunion and Celebration of Life Sept. 1st -8th 2012
Speaker/Presentation Application/Proposal
Deadline for Submission: May 20, 2012
Email: steviejoelliescancercarefund@gmail.com
Subject Line: Speaker Proposal
Presentation Track Please choose the category that best fits your
Select Only One presentation topic and target audience.
Page | 3
Thyroid Cancer Patients ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Thyroid Cancer Survivors ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Caregivers and Loved Ones ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
HealthCare Professionals ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Health and Wellness ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Please review the following SJCCF Speaker and Presenter Policies prior to
submitting your presentation description:
 Stevie JoEllie’s Cancer Care Fund does not pay for travel expenses or speaker fees.
 Stevie JoEllie’s Cancer Care Fund requires that your presentation and materials be your
own original work or have obtained any necessary copyright permissions.
 Stevie JoEllie’s Cancer Care Fund does not allow sales pitches or self promotion in their
presentations. All information is to be presented in a fair and balanced context. Content
should be based upon a relevant topic, concept or idea, not a specific product or service.
 Stevie JoEllie’s Cancer Care Fund requires that if your topic is selected, that all handout
materials be submitted a minimum of 2 weeks before the conference.
 Stevie JoEllie’s Cancer Care Fund asks that you register for the Event if you are planning
on attending beyond your own session.
Signature:______________________________________ Dated:________________________
Printed Name:__________________________________ Title:__________________________
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