Presenter Participation Agreement Healing Trauma, Healthy Communities Conference September 26-28, 2018 Milwaukee, WisconsinPresenter Participation Agreement Thank you for presenting at the Healing Trauma, Healthy Communities Conference hosted by SaintA and the Scaling Wellness in Milwaukee initiative.Please complete the following information about your breakout session so that we can ensure a successful conference experience for you and our guests. Please remember to register for the conference using the Presenter Registration Code.If you have questions or require further assistance, please contact Sandy Engelhardt at firstname.lastname@example.org.Name of person completing this form:*** If you are a presenter for more than one session, please complete an additional form for each session. ***(complete this form, click submit at the bottom and refresh this page)Name* First Last Email* Cell Phone*Title*Organization*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Co-PresentersCo-Presenters (if applicable)*I have no co-presentersI have co-presentersPlease provide contact information for each workshop co-presenter. If your co-presenter infomration changes, please notify us at email@example.com.Co-Presenter 1's Name First Last Co-Presenter 1's Email Co-Presenter 1's Cell PhoneCo-Presenter 2's Name First Last Co-Presenter 2's Email Co-Presenter 2's Cell PhoneCo-Presenter 3's Name First Last Co-Presenter 3's Email Co-Presenter 3's Cell PhoneCo-Presenter 4's Name First Last Co-Presenter 4's Email Co-Presenter 4's Cell PhoneCo-Presenter 5's Name First Last Co-Presenter 5's Email Co-Presenter 5's Cell PhoneCo-Presenter 6's Name First Last Co-Presenter 6's Email Co-Presenter 6's Cell PhoneCo-Presenter 7's Name First Last Co-Presenter 7's Email Co-Presenter 7's Cell PhoneWorkshop Descriptions & TitlesYour workshop title and description can be found here. Please review the information and let us know if you require any changes. Please note your description and/or title may be edited to best fit our marketing materials.*My workshop title, description and presenter information is correct.I request changes be made to my title, description and/or presenter informationI need changes to my workshop title:I need changes to my workshop description:I need changes to my workshop presenter information:Audio VisualPlease indicate your audio visual needs:* I need a laptop I will use my own laptop LCD Projector & Screen Flipchart paper and markersIF using your own laptop:I will be presenting from a PCI will be presenting from a MacPresenter Authorization*I hereby agree to present at the Healing Trauma, Healthy Communities Conference. I affirm that, to my knowledge, none of the material presented, either verbally or in written materials, in the context of my presentation, infringes upon any copyright or any person’s right to privacy. Further, I will not libel or slander any other person, facility, company, product or service during my presentation. If such affirmation is breached, I indemnify and hold harmless SaintA and all contracted service providers.*I understand that SaintA cannot permit any presenter to use their presentation to make a “sales pitch” for any specific firm, publication or service. Presenters may, after their scheduled speaking time, provide participants with an opportunity to purchase publications or materials.*I agree to allow SaintA to post and retain my presentation materials on the conference website.EmailThis field is for validation purposes and should be left unchanged.