Virginia Inclusion Summit – Presenter

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Workshop Presenter

Please use this form to provide VCIC with all pertinent information for your workshop. Information entered on this form may be reproduced to market the conference and other VCIC programs. This form also serves as your registration for the conference. You will not need to complete a separate registration form. If you have any questions or concerns, please reach out by phone at 804-515-7950 or send an email to Jacquie or Katie.

Name *

Title / Organization *

Please write your title and organization/affiliation as you want in print.

Phone *

Provide a phone number you can be reached on the day of VIS (cell preferred)

Email *

Social Media Handles

If you would like to, please provide your or your organizational social media handles (Facebook, Twitter, Instagram, LinkedIn, etc). These will be added to your profile on the event website, so only provide if you want VIS attendees to have access.

Your Biography *

Please provide a short professional bio for marketing purposes. (Max 175 words)

Professional Headshot

Please upload a head and shoulders photo (acceptable formats .jpeg, .png)

Workshop Name

Indicate title, if you would like to suggest a title other than what is listed in your invitation. (Max 175 characters)

Workshop Description *

Please include a description of your workshop. (Max 100 words)

Workshop Learning Objectives *

Please write 4 sentences listing the goals/outcomes you expect attendees to take away from your workshop. (Max 150 words)

Technology / Room Needs *

The Westin Richmond has full A/V capabilities. Please indicate your technology and/or room preferences below.

I would like to use my personal laptop.

I would like for a laptop to be provided. I will email the presentation in advance or present my content using an usb drive.

Flip Chart (with markers and butcher paper)

Other (please use space below to describe additional needs)

Any additional information you want us to know about technology and/or room needs?

Accommodations

Please share any specific accommodations that should be considered as we plan for the conference (i.e., hearing loss, vision loss, etc.).

Other/Additional Information for VCIC