2022 Virtual Summit Breakout Session Form | The Bucks-Mont Collaborative for Health & Human Services

Session Contact Name *

First

Last

Email *

Phone *

Session Description *

We will share this with attendees.

Session Goals & Objectives *

We will share this with attendees.

Presenter(s) Names and Credentials *

Please list as you would like included in the summit materials.

Upload Your Resume or Bio *

Click or drag a file to this area to upload.

(.pdf, .doc, .docx, .jpg, .jpeg)

Upload Your Photo

Click or drag a file to this area to upload.

We will include in applicable summit materials. Please skip this upload if you would prefer to not include a photo. Thank you.

Presenter Email *

Presenter Phone *

2nd Presenter Email

2nd Presenter Phone

Additional Presenter(s) Email

Additional Presenter(s) Phone

May we share the presentation materials with all summit attendees post-event? If not, we will only share them with our CEU provider for documentation. *

May we record your session? *

Do you have a maximum number of attendees for your session? *

May we use your Zoom account to host this session? *

We have found that this is logistically easier for speakers the day of events.

Please share any additional information or needs.