Speaker Agreement

Thank you for agreeing to participate in the 2021 virtual Heading Forward Conference taking place May 6th and 7th. The information requested will be used for the online program, to promote the event and for continuing education certification purposes.

Name
First Last
Title
Company/Organization
Email
Phone
Session Title
Session Objectives (at least 3)
Session narrative (description used for program)
Upload your bio here or use the space below to provide a brief bio
Max. file size: 512 MB.
Brief bio
Special requests or accommodations
For example, requests such as sound, video, etc.
Upload your CV if available.
Max. file size: 512 MB.
Consent * Required
I agree to the following requests:
1. Debra Holloway (debra@biav.net) at the Brain Injury Association of Virginia will be your contact moving forward for all logistical information and questions regarding your presentation.
2. Presenters will be asked to provide all handouts and materials one week prior to their presentation date.