Panelist and Moderator Agreement for the 2022 APFM Annual Conference

Are you a Moderator or a Panelist?

Moderator

Panelist

Speaker Info

First Name *

This will be listed on all conference materials.

Last Name *

This will be listed on all conference materials. Please include all designations.

Textable Phone Number *

We need a phone number to which we can text you on the day of the session.

Email *

Confirm Email *

Address

City

State/Province

Zip/Postal

Country

Section for Moderators

Technological Needs

Presentation Content - Moderators Complete

Course content level:

Beginning/Introductory

Intermediate

Advanced

Panel Promotional "Blurb" - 100-200 words

List 5–7 bullet points summarizing main points of workshop.

List 3 learning objectives. Format as what participants will be able to DO after the session, not what the presenter intends to COVER during the session.

Bibliography

Provide 3-4 current (within the last 5 years) scholarly sources that pertain to the content of your panel. Please do not include more than one source of which you are the author.

Speaker Agreement

Participation *

I will speak as a panelist or moderator on the panel that I have been invited to join.

Technology *

I will join the panel via Zoom, using a device with a camera, microphone, and stable internet connection. I will use the Zoom link provided to me and I will not share that link with any person.

Expenses *

I understand that any expenses incurred to participate in this conference are my responsibility, and I will not be reimbursed by APFM.

Registration *

I understand that if I wish to attend other panels or workshops, I will need to register for the conference. (Register here.)

Notification *

I will notify APFM immediately in the event that I am unable to meet my commitment as a speaker and understand that APFM is counting on me to present at the conference.

For questions, please contact APFM at [email protected] or 802-823-2566.

Content *

I warrant and represent that, to the best of my knowledge, nothing in my presentation violates any proprietary or personal rights of others (including, without limitation, any copyright or privacy rights), is factually accurate, and contains nothing libelous or otherwise unlawful.

Release

I AGREE THAT THE ACADEMY OF PROFESSIONAL FAMILY MEDIATORS MAY:

Use of Name and Bio *

Use my name and biographical data in any promotional material (print or online) developed in connection with the conference.

Use of Content *

Reproduce and republish in print, recorded media or online the presentation and remarks of my presentation. For example, video or audio files of my presentations may be provided to conferences attendees free or for a charge. Additionally, the video or audio recording may be given or sold after the conference.

Use of Content for Members *

Reproduce and republish in any form and in any media tables, charts or other written or visual material used by me as part of my presentation for the benefit of APFM members. In addition, any media tables, charges and other written or visual material from a presentation may include as part of a sale of the video or audio recording after the conference to the APFM membership or members of affiliate organizations.

Understanding *

I understand and agree to the above conditions.

Questions, please contact:

Kacy Wiant, APFM Administrator
[email protected]

Signature and Agreement Submission

Today's Date *

Signature *

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Panelist and Moderator Agreement