2023 Workshop Presenter Intake - REGENERATE Conference

2023 Regenerate Workshop Presenter Intake Form

"*" indicates required fields

Speaker Information

Items marked with a + will be included on the conference website and in the program.

Name +*

First Last

Pronouns (optional)

Email*

Please enter the primary email address we should use to communicate with you regarding your presentation, registration, and other logistics.

Email +*

Please enter the email address that you would like to have listed in the conference program. Please notify us at [email protected] if you don't want your email listed in the program.

Phone*

There may be times when we need to contact you by phone regarding logistics. Please enter the number you'd like us to use.

Primary Title and Affiliation +*

The primary title and affiliation you enter here will be included on the conference website and virtual platform, and in the program. You have the option to submit a secondary title and affiliation below. If space allows, we may list the second title and affiliation, as well.

Secondary Title and Affiliation

If you'd like to submit a secondary title and affiliation, please complete this section. If space allows, we may also list the second title and affiliation on the conference website and in the program.

City and State +*

City State / Province / Region Country

Photo(s) +*

Drop files here or

Accepted file types: jpg, jpeg, tif, png, gif, Max. file size: 15 MB, Max. files: 4.

Please upload a headshot and/or photo(s) of yourself doing the work you love! You can upload up to four photos in the following formats: JPG, JPEG, TIF, PNG, and GIF. The maximum file size allowed for each photo is 15MB.

Personal Bio +*

150 word limit, please prepare in 3rd person. Please note that we will copyedit and proofread your bio before posting it, but we will not alter its content.

Website +

Have you published books, papers, and/or articles that you'd like us to showcase online?*

Yes

Please list the title(s) and/or URLs of your publications.*

Social Media Links

Please list links or handles to social media accounts that you would like to have associated with the REGENERATE Conference.

Lunch will be provided. Do you have any dietary restrictions?

Yes

If yes, what restrictions do you have?

Presentation

Please give us some information about your presentation or workshop.

Title of Presentation