New Presenter Info Needed

Dear Prospective 2009-10 Interface Presenter,

Thank you for offering to present at Interface! The Interface program committee is excited and honored to have you join us as part of our scheduled program lineup next year.

We will be publicizing your presentation in our annually distributed printed brochure schedule and online at, www.InterfaceBoulder.org this Summer. To ensure the accuracy of your information, please fill out and submit the information requested below by June 1st, 2009.

If you have any questions, please contact the Interface program committee member with whom you may already be in touch with or email Barry Erdman: be@BoulderTherapist.com) Interface Coordinator (303 444-1404).

Thank you for taking the time to do all this!

Please Submit the Following Information by 6/1/09!
(For examples, go HERE and click on the "MORE INFO >>>" button under any presentation listed.)

2009-10 PRESENTER SUBMISSION FORM

PERSONAL INFORMATION:

First Name, Last Name:

Credentials:

Affiliation:

Mailing Address, Line 1:

Address, Line 2:

City:State:Zip:

Email Address:

Phone numbers:

Evening:

Daytime:

Cell/Other:

ABOUT MY PRESENTATION:

TITLE:

DESCRIPTION:

MY BIO:

ADDITIONAL RESOURCES:

PREFERRED DATE FOR MY PRESENTATION: Available Dates:
2009: (Sept 16th, Oct. 21st, Nov. 18th, Dec. 16th)
2010: (Jan. 20th, Feb. 17th, March 17th, April 21st, May 19th, June 16th, July 21st.)

1st Choice:	2nd Choice:	3rd Choice:

Months I am NOT available to present:

DIGITAL PHOTO:
We'd also like to post your photo on our web site. Please email your .jpg photo as an attachment now before you complete submitting your info. Don't forget to include your name in the email. Click this button to send your photo:

Interface Presentation Details:
Interface meets on the 3rd Wednesday of each month (except August). We typically average between 20-40 attendees at a meeting comprised primarily of Boulder County mental health clinicians and clergy. The meeting format and dress is informal but professional. A continental breakfast is available from 7:15-7:30am from the cafeteria near the conference room you'll be presenting in. Announcements and participant introductions start promptly at 7:30am. Your presentation will be about an hour, starting around 7:40 and concluding at 8:45. We request that at least 15 minutes be allocated for group discussion and Q&A within your presentation time. The intention is to end the meeting by 8:45am so attendees that need to can get to their 9am appointments. Attendees may linger afterwards to talk further with you till 9am.

Equipment available: flip chart pad, big screen TV and players to show dvd or vhs, overhead projector, screen. A digital projector and laptop may be available only with advance notice.

You are also welcome to bring marketing brochures, books, or other related literature with you to distribute or sell.

We typically audio record your talk for others who may be interested but could not attend. Please let us know if you do not wish to be recorded. We can provide a CD audio recording of your presentation to you at no cost.

We can not offer an honorarium to you for your presentation. However you are invited to attend any or all of the other Interface programs within the season’s schedule in which you are presenting (continental breakfast included) at no cost. Please also consider attending any Interface programs prior to your presentation to get a feel for the group.

Comments/Questions?:

I would like to be added to the meeting notification email list, and receive a reminder a week in advance of each program.

NOTE: Please remember to E-Mail a digital photo of yourself now to: be@BoulderTherapist.com

PRINT this page for your records, BEFORE you submit !