National Convention CEU Speaker Verification Information

CEU Speaker Verification Information

Information provided will be used to approve a speaker for Continuing Education Units. Information provided will also be used on the conference event website/app.

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About You

Your Name(Required)

First Last

Title/Position(Required)

Your Address

Street Address Address Line 2 City ZIP Code

Bio(Required)

Bio

Max. file size: 32 MB.

Feel free to upload a file of your course outline if preferred.

Company Website(Required)

How Can We Reach You?

How can we get in touch?

Preferred Method of Contact

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Best Time to Call You

Speaking Details

Please complete all of the required fields below. If attaching files, simply state "Attached" in the required fields.

How Much Speaking Time Will You Need?(Required)

Speaking Time Needed (1, 2, or 3 hours)

What is your preferred speaking date/time?(Required)

Would you prefer speaking on Friday or Saturday? Morning or afternoon?

Course Title(Required)

Name of course

Instructor(Required)

List one instructor’s name or lead instructor, plus approved co-instructors.

Course Objective(Required)

One or two sentences that state tire subject matter.

Course Objective

Max. file size: 32 MB.

Feel free to upload a file of your course outline if preferred.

Statement of Purpose(Required)

Provide a brief rationale for the purpose of the course.

Statement of Purpose

Max. file size: 32 MB.

Overview of Course(Required)

A brief, condensed paragraph on the overview of the course.

Overview of Course

Max. file size: 32 MB.

Course Outline(Required)

This MUST be an Hour- by- Hour outline (one hour each-must be 60 minutes rather than 45 minutes, 1 hour and 30 minutes, etc.). CE Credit is only approved for 50–60-minute hours. Each hour must include a minimum of one sentence to describe the ACTUAL material to be covered during the hour. Opening or closing remarks will not count toward continuing education and should not be counted in the outline. Each hour must state ONE subject matter topic for which CE hours are requested. The topic must be next to the hour, to the right, as shown. Please include any lunch or dinner breaks in your outline. Lunches may be no longer than one even hour or two even hours.

Course Outline

Max. file size: 32 MB.

CV, Chiro License, High Resolution Headshot

Please upload a copy of your CV, copy of license with state and license number clearly visible, and high-resolution headshot below.

CV(Required)

Max. file size: 32 MB.

Please upload a copy of your current CV.

Chiropractic License(Required)

Max. file size: 32 MB.

Please upload a copy of you license with state and license number clearly visible.

High-Resolution Headshot(Required)

Max. file size: 32 MB.

Please submit a high-resolution headshot for the website and convention event app.