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D.A.R.E. Presentation Proposal Online Submission
for the 2018 Annual D.A.R.E. International Training Conference
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Presenter Information
Name
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Title
First
Last
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Title
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Professional Affiliation
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Mailing Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Curacao
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Day Time Telephone
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Evening Telephone
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Fax Number
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Email Address
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Curriculum Vitae (please upload)
Proposed Presentation Summary
Presentation Title
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Presenter
*
Title
First
Last
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Co-Presenter
Title
First
Last
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Co-Presenter
Title
First
Last
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Intended Audience
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Presentation Summary
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Learning Objectives
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Instructional Methodologies Employed
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Time Requirement for Presentation
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1 hr 45 min
3 hrs 30 min
Number of Workshops willing to conduct:
(It is requested if you do 1.45 hr workshop that you do a minimum of 3. If you do 3.5 hr workshop that you do a minimum of 2)
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2
3
Other
Maximum Allowed:
250
characters.
Currently Used:
0
characters.
Schedule/Presentation Limitations:
Venues (Organization, Location, Date) at which this presentation has been made:
Available presentation dates:
*
July 10, 2018
July 11, 2018
July 12, 2018
Please include following information as attachments:
Bio
Photo
Video (If available)
or paste the video URL(s) below
Workshop description for inclusion in D.A.R.E. Conference book
Presentation Logistical Considerations
Presenter(s)
*
Presentation Title
*
Audience Size
*
Under 25
25 to 50
50 to100
100 to 500
Unlimited
Other
Maximum Allowed:
250
characters.
Currently Used:
0
characters.
Preferred Room Configuration
*
Theater
Classroom
Rounds
Other
Maximum Allowed:
250
characters.
Currently Used:
0
characters.
Audio/Visual Needs
*
LCD Projector
35 mm Projector
Overhead Projector
Screen
Microphone
Microphone (Wireless)
Tape Player
CD Player
Other (please specify in the Other Audio/Visual Needs field below)
None
Other Audio/Visual Needs
Handout Materials (attach/forward all handouts)
Do you need to attach more handout files?
*
No
Yes
If you need to submit more handout files, please email them as attachments to mistie.bellrenfro@dare.org. Please mention that you submitted your proposal through the online form and include the presentation title and the name of the presenter(s).
Number of handouts
Please check the box below.
*
Do Not Fill This Out