Medical Transcription Industry Association

Session Title:

Presenter Name:

I am:

Title:

Credentials (as they appear after your name):

Organization/Business/Employer:

Mailing Address:

City:

State:

Zip:

Phone:

Fax:

Cell (for onsite only):

Email Address:

Are you a member of MTIA?

Yes No

Have you presented at a MTIA Annual Conference before?

Yes No

Have you presented this session at another meeting/conference?

Yes No

If yes, please indicate the name/date of the meeting/conference:

Are you identified in another 2010 conference proposal?

Yes No

If yes, title of proposal:

Suggested length of presentation:

Additional Presenters: If there are additional presenters please submit a separate form with their name, credentials, job title, organization, contact information and electronic signature. MTIA will not accept more than four presenters for any given presentation. Please note the primary presenter will serve as the main session contact and will be responsible for the session.

Session Abstract: Provide a 150 to 200 sessioin overview for your proposed presentation. This overview will be used as the "session description" in the conference program. Please include as to how your session will benefit attendees:

Biosketch: Provide a 100 word or less description of speaker(s) background and/or qualifications for giving this presentation. Volunteers will read this bio to introduce you before your presentation:

Presentation Aids Required (Mark only what is needed)

LCD Projector
Other (please explain):

Note: MTIA will not provide computers onsite. All speakers must bring their own laptop for their presentations. We will have every room prepared for laptops to easily plug into.

Who is the target audience? (Please type in your answer)

Presenter Consent
Check the following boxes if you agree to allow MTIA to:

Audio record presentation for a post-conference CD or cassette.
Video record presentation for a post-conference DVD.
Promote speaker in all MTIA publications and conference programming.

Recording Disclaimer
Conference recordings offer MTIA members who couldn't attend the conference an opportunity to obtain all the critical, relevant information that was shared by all the presenters. The recordings will be sold for personal use to those wanting to catch what they'd missed or retain a permanent copy for further absorption at a later date. The price charged will cover production costs, labor, equipment, and supplies paid by MTIA.

Power Point Slide Submission Deadlines
Making the presenter’s PowerPoint slides available in notes/handouts format is a standard practice at MTIA and considered vital by our attendees. Therefore we require all presenters to send their Power Point file to Andrew Wolf via email: awolf@mtia.com by February 15, 2010.

Speaker Photo
All presenters, upon receiving an official invitation from MTIA staff that they've been chosen to present at the annual conference must submit a professional headshot image to Andrew Wolf (awolf@mtia.com) immediately. This will be used in the conference program book.

Handouts Policy
MTIA appreciates avoiding the expense and environmental foot-print involved with printing handouts for all break-out speaker sessions, thus handouts are not required at any presentation. If providing a handout is critical to the success of your presentation, please send no more than two pages in MS Word format to Andrew Wolf via email at (address seen above) by February 15, 2010.

Speaker Signature
My electronic signature below shows that I understand if my proposal is accepted I am required to submit all materials by the deadlines mentioned above. I also understand that MTIA is unable to reimburse travel or lodging expenses for its break-out session presenters.

To complete the electronic signature, please type your name in the box below. Your typed name will be recognized as your signature.

Electronic Signature:

Please note: The Committee will not consider sessions that do not have signatures and consent for all presenters.