Primary Speaker's Name

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* 1. First Name:

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* 2. Last Name:

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* 3. Agency Name (If not applicable place a N/A in the box):

Contact

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* 4. Address:

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* 5. City:

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* 6. State:

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* 7. Zip Code:

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* 8. Phone Number:

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* 9. Email address:

Session Title

The title of your session is the first impression for summit attendees. Use a concise, but inclusive, title which clearly conveys what you will be presenting and draws attendees' attention to your topic.

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* 10. Title of Your Session:

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* 11. Category:

Session Abstract

Your session abstract will tell summit attendees why they should attend your session. To be effective and create interest, it should provide a brief, clear, and concise reflection of your presentation’s content. The abstract should only be one paragraph of between 150 to 250 words in length.

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* 12. Outline of Key Elements

List 4 to 5 primary or key elements of your topic that you will be discussing.

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* 13. Have you given this presentation before and/or you do you intend to present it elsewhere in the near future?

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* 14. Length of presentation?

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* 15. Please fill out the speaker information below or upload a document with speaker bios:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
Speaker #1

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* 16. Speaker Name #1

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* 17. Tribal Affiliation?

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* 18. Bio for Speaker #1

Speaker #2

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* 19. Speaker Name #2

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* 20. Tribal Affiliation?

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* 21. Bio for Speaker #2

Speaker #3

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* 22. Speaker Name #3

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* 23. Tribal Affiliation?

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* 24. Bio for Speaker #3

Speaker #4

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* 25. Speaker Name #4

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* 26. Tribal Affiliation?

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* 27. Bio for Speaker #4

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* 28. I agree to submit my presentation prior to the summit

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* 29. I understand that my presentation will be available on the MMIWP Task Force website

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* 30. I have verified that all information provided is accurate and complete

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