AMTA Speaker Pool Application

The deadline for the call for applications for the AMTA 2009 National Convention in Orlando, FL September 23-26, 2009 has passed.

Please check back in Spring 2009 for the call for applications for the AMTA 2010 National Convention in Minneapolis, MN September 22-25, 2010.

If you would like your name added to the distribution list to receive the Call for Speakers application when it becomes available, please email us at aelston@amtamassage.org.  Please note your name and that you are interested in receiving the Call for Speakers documents.

Should you have questions about the national convention’s educational programs, please contact us at mvahlkamp@amtamassage.org

 

PRESENTER INFORMATION

Your Name
Title
Organization
Work Phone
Fax
E-mail Address
Street Address
City
State
Zip Code
Country
Preferred method of contact: Email Physical Mail
Are you an AMTA Member? Yes No
If yes, please enter your AMTA Member ID:

APPLICATION

Topic
In the space provided below, please complete a summary of the presentation you are submitting. Include the topic and title, the length of the presentation, and the level of difficulty—beginning, intermediate or advanced.

Please check if the proposal listed below is already on file in our Speaker Pool.

   

Length

Level

Hands On
Topic 3 hour      8 hour   beginning   intermediate   advanced     Yes   No  
    4 hour    16 hour              
Title  

Continuing Education

Learning Outcomes: List outcomes in behavioral/measurable terms which are attainable, can be evaluated and are relevant to the practice of massage therapy and bodywork

Program Content: List program content which reflect learning outcome.

Time Frame:
% hands on:
% interactive:
% lecture:

Bibliography: List references that support the subject matter presented for each learning objective.

Teaching Strategies: List strategies used by each presenter of program content.

Learning Environment: Fully describe environment which supports principles of continuing professional education.

Resume
Please email your resume or professional vitae to Heather Stearns at aelston@amtamassage.org. Be sure to include the following sections:

  • Education
  • Certification(s)
  • Teaching Experience
  • Publications
  • Professional Affiliation(s)
  • Awards and Honors

Sample of Handouts
Please email Amanda Elston at aelston@amtamassage.org any handouts you plan to provide to the attendee. The handouts should NOT exceed 20 pages doubled-sided and should reflect the program content.

Teaching Sample
Upon completion of this form, please mail a VHS or DVD of a teaching sample to:

Amanda Elston
AMTA, 500 Davis St., Ste. 900
Evanston IL 60201-4695

If you already have a teaching sample on file, you are not required to submit a new one.

Submit Application
Upon completion and acceptance of this application, your name will be added to the AMTA National Speaker Pool.
I would like my name forwarded to AMTA’s state/regional/chapter conference planners.    Yes   No
I hereby attest that the information submitted is accurate to my knowledge.    Yes    No